Liver transplantation in the United States: a report from the Organ Procurement and Transplantation Network

Abstract

TRANSPLANTS AND CENTERS: Between 1988-1999 the number of annual liver transplants performed in the United States more than doubled, from 1,713 to 4,689; the number of centers increased from 59 to 117. The number of living donor, segmental, and multiple organ transplants also increased over time, particularly between 1997-1999. The rate of increase in the number of centers has slowed over the last few years.

Outcomes: Survival among pediatric recipients The one- and 10-year graft survival rates for pediatric recipients were 76% and 63%, respectively. The one- and 10-year patient survival rates were 85% and 78%. Patient survival did not decrease much after the first 2 years and graft survival stabilized after 5 years. Some of the factors associated with increased odds of graft failure and patient death at 6 months after transplantation included having a previous transplant; being hospitalized, in the ICU, or on life support at the time of transplant; a creatinine level > 2 mg/dl; donor race/ethnicity; and transplant type. Factors associated with decreased odds of graft failure or patient death were recipient gender, having a metabolic disease, and a shorter than average cold ischemia time. Among grafts, recipients surviving the first 6 months after transplantation, recipient and donor race/ethnicity, primary liver disease, and having a previous transplant were associated with a greater relative risk of graft failure and mortality. The risk of graft failure was reduced for recipients in the ICU at the time of transplant and for those receiving organs from younger donors. Survival among adult recipients The one- and 10-year graft survival rates among adult recipients were 79% and 51%, respectively. The one- and 10-year patient survival rates were 85% and 59%. Survival rates decreased steadily at all time points following transplantation. Some of the factors associated with increased odds of graft failure and mortality at 6 months were increasing recipient and donor age; recipient and donor race/ethnicity; primary liver disease; having a previous transplant; being hospitalized, in the ICU, or on life support at the time of transplant; longer cold ischemia time; having a non-identical recipient/donor blood type match; transplant type; and year of transplant. Younger recipient and donor ages, having cholestatic liver disease/cirrhosis, shorter cold ischemia times, and matching male recipients with male donors were associated with decreased odds of graft failure and mortality. Many of these characteristics also affected grafts and patients surviving the first 6 months, including recipient and donor age, recipient and donor race/ethnicity, primary liver disease, previous transplant, and year of transplant.