Introduction The ability to preserve organs prior to transplant is essential to the organ allocation process. Objective The purpose of this study is to describe the functional relationship between cold-ischemia time (CIT) and primary nonfunction (PNF), patient and graft survival in liver transplant. Methods To identify relevant articles Medline, EMBASE and the Cochrane database, including the non-English literature identified in these databases, was searched from 1966 to April 2008. Two independent reviewers screened and extracted the data. CIT was analyzed both as a continuous variable and stratified by clinically relevant intervals. Nondichotomous variables were weighted by sample size. Percent variables were weighted by the inverse of the binomial variance. Results Twenty-six studies met criteria. Functionally, PNF%=− 6.678281+ 0.9134701* CIT Mean+ 0.1250879*(CIT Mean− 9.89535) 2− 0.0067663*(CIT Mean− 9.89535) 3, r2=. 625,, p<. 0001. Mean patient survival: 93%(1 month), 88%(3 months), 83%(6 months) and 83%(12 months). Mean graft survival: 85.9%(1 month), 80.5%(3 months), 78.1%(6 months) and 76.8%(12 months). Maximum patient and graft survival occurred with CITs between 7.5–12.5 hrs at each survival interval. PNF was also significantly correlated with ICU time,% first time grafts and% immunologic mismatches. Conclusion The results of this work imply that CIT may be the most important pre-transplant information needed in the decision to accept an organ.