Liver transplantation is being increasingly performed for multiple non-neoplastic and neoplastic conditions, which has resulted in an increased demand for liver donors. In 2022 a total of 9528 liver transplants were performed in the U.S. with 10,211 candidates waiting in the United Network for Organ Sharing (UNOS) database [1]. As this shortage continues to increase there is an increased desire to optimize organ allocation and donor liver biopsies play an important role in organ selection. Histologic factors associated with poor graft outcomes include moderate and severe steatosis, parenchymal necrosis, and advanced fibrosis [[2], [3], [4], [5], [6], [7], [8]]. Chronic hepatitis with more than mild activity may also result in donor deferral [4].

During the pre-transplant evaluation of liver donors, we have occasionally encounter unexpected abnormalities in either a liver biopsy or extrahepatic lesions. In our review of the literature, these unexpected findings have not been documented to date. By contrast, incidental findings in other procedures such as Whipple [9], bariatric [10] and other abdominal surgeries [11] are well documented. Hence, in this study we sought to describe our experience with incidental histologic abnormalities identified in liver biopsies and extrahepatic tissues identified during the pretransplant evaluation.