Liver

OPTN/SRTR 2020 Annual Data Report: Liver

Abstract

This year was marked by the COVID-19 pandemic, which altered transplant program activity and affected waitlist and transplant outcomes. Still, 8906 liver transplants were performed, an all-time high, across 142 centers in the United States, and pretransplant as well as graft and patient survival metrics, continued to improve. Living donation activity decreased after several years of growth. As of June 30, 2020, 98989 liver transplant recipients were alive with a functioning graft, and in the context of increasing liver transplant volume, the size of both the adult and pediatric liver transplant waitlists have decreased.

On February 4, 2020, shortly before the pandemic began, a new liver distribution policy based on acuity circles was implemented, replacing donor service area- and region-based boundaries. A policy change to direct pediatric livers to pediatric recipients led to an increase in deceased donor transplant rates and a decrease in pretransplant mortality rate among children, although the absolute number of pediatric transplants did not increase in 2020.

Among adults, alcohol-associated liver disease became the predominant indication for liver transplant in 2020. After implementation of the National Liver Review Board and lower waitlist priority for most exception cases in 2019, fewer liver transplants were being performed via exception points, and the transplant rate between those with and without hepatocellular carcinoma has equalized. Women continue to experience higher pretransplant mortality and lower rates of liver transplant than men.

Adult Transplant

Waiting List Registration

A total of 24936 candidates were listed for liver transplant, with 12409 newly added and 13164 removed during the year (Figure LI 1, Figure LI 2, Table LI 4). As the number of transplants in the past decade has consistently increased, the size of the waitlist has decreased, albeit slightly, with 11772 candidates still waiting on December 31, 2020 (Table LI 4).

The proportion of older (aged ≥65 years) candidates continued to increase, representing 21.7% of the adult waiting list in 2020, compared with 9.4% in 2010 (Figure LI 3). The sex and racial composition of the waiting list has remained relatively unchanged: 61.6% male, 38.4% female, 68.7% White, 7.0% Black, 17.9% Hispanic, and 4.8% Asian (Figure LI 4, Figure LI 5).

Alcohol-associated liver disease and other/unknown diagnosis (often representing liver disease due to non-alcoholic steatohepatitis) are now the leading indications for liver transplant listing, whereas the proportions of acute liver failure, cholestatic liver disease and, especially, hepatitis C virus (HCV) have declined (Figure LI 6). Candidates with a primary diagnosis of hepatocellular carcinoma (HCC) composed 10.9% of new waiting list registrations, which has nearly doubled over the past decade.

The severity of liver disease, based on the first active laboratory model for end-stage liver disease (MELD) during the calendar year, has increased, with a greater proportion of listings with MELD 25-34 (12.0%), MELD 35-40 (3.4%), and MELD 40+ (3.0%) (Figure LI 7). Candidates with body mass index (BMI) ≥35 kg/m2 composed 17.8% of the waiting list, representing the only BMI category with a steadily increasing trend (Figure LI 8). In 2020, 3.2% of candidates had a history of liver transplant (Figure LI 10).

Compared with 2015, the number of liver candidates willing to accept HCV-positive donors increased nearly three-fold (60.2% vs 21.0%), reflecting a distinct shift in attitudes over the past five years owing to the availability of direct-acting antiviral (DAA) therapy (Figure LI 11).

Waiting List Outcomes

The overall deceased donor transplant rate among adult waiting list candidates has risen to 65.2 per 100 waiting list-years in 2020 from 35.7 per 100 waiting list-years in 2009 (Figure LI 12). The increase occurred across all age-groups, major racial/ethnic groups, blood types, and places of residence (metropolitan vs non-metropolitan) (Figure LI 13, Figure LI 14, Figure LI 15, Figure LI 18). Women continued to experience a lower deceased donor transplant rate than men (59.9 vs 68.6 per 100 waiting list-years) (Figure LI 17). The gap between candidates with and without HCC exception points continued to narrow (79.0 vs 63.7 per 100 waiting list-years), reflecting the May 2020 policy lowering waitlist priority for exception cases (Figure LI 16).

Of the adults listed for liver transplant in 2017, 58.0% received a transplant (including 2.3% from a living donor), 10.1% died, and 23.4% were removed from the list for other reasons without undergoing transplant, leaving 8.6% still waiting (Figure LI 19). In a competing-risk framework for time from listing to transplant, the median waiting time among patients listed in 2020 decreased across the board, with patients listed as status 1A waiting a median of 0.13 months (4.0 days), those with MELD ≥35 waiting 0.16 months (5.0 days), and those with MELD 15-34 waiting 4.2 months (Figure LI 20). In absolute terms, of candidates listed in 2019, 32.8% received a deceased donor liver transplant within 3 months, while 39.4% received one within 6 months, and 50.2% received one within 1 year. (Figure LI 21).

Geographic differences in deceased donor transplant rates persisted, ranging from 32% to 87% at 3 years by donation service area (DSA) (Figure LI 22) and 31% to 83% by state of residence (Figure LI 23). The highest rates were seen in South Carolina, Puerto Rico, Mississippi, Louisiana, and Indiana, and the lowest in South Dakota, North Dakota, Montana, Vermont, and Alaska, only one of which (South Dakota) has a transplant center.

The pretransplant mortality rate in 2020 was 12.2 per 100 waiting list-years, an all-time low (Figure LI 24). Higher rates of pretransplant mortality were observed among women than men (13.1 vs 11.6 deaths per 100 waiting list-years) (Figure LI 27). Pretransplant mortality was highest among those with acute liver failure (19.0 deaths per 100 waiting list-years) and lowest among those with HCV or HCC (9.1 deaths per 100 waiting list-years for both groups) (Figure LI 28). Overall, pretransplant mortality has improved in the higher MELD categories (ie, MELD 25 or greater), although it was still high for those with MELD 35-40 or 40+ (167 and 124 deaths per 100 waiting list-years, respectively) (Figure LI 30). Pretransplant mortality has decreased among candidates with HCC exceptions (Figure LI 31). DSA-level pretransplant mortality rates still varied, ranging from 6.0 to 21.7 deaths per 100 waiting list-years (Figure LI 32).

The most common reason for waiting list removal was deceased or living donor transplant (63.4%), followed by death or being too sick for transplant (18.0%), other reasons (10.9%), and condition improved and transplant no longer needed (6.9%) (Table LI 5). Deaths within 6 months after removal from the waiting list for reasons other than transplant increased to 18.2%, with higher rates among older age groups and MELD categories (Figure LI 33, Figure LI 34, Figure LI 35).

Donation

The number of deceased liver donors continue to increase, reaching an all-time high of 9211 in 2020, despite fewer pediatric donors (age <18) (Figure LI 36, Figure LI 39). The sex and racial composition of donors has remained relatively unchanged: 61.4% male, 38.6% female, 63.3% White, 17.8% Black, 15.1% Hispanic, and 2.8% Asian (Figure LI 40, Figure LI 41). HCV-positive organs made up 9.7% of deceased donor livers recovered in 2020 (Figure LI 38, Figure LI 42).

Overall, 9.5% of livers recovered were not transplanted; livers from older donors were less likely to be transplanted (Figure LI 44, Figure LI 45). Livers with positive hepatitis C antibody and those at increased risk of disease transmission were not more likely to be discarded (Figure LI 49, Figure LI 50). The discard rate of livers from donors after circulatory death (DCD) was lower than in previous years, but DCD livers remained much more likely to not be transplanted than livers recovered from donors after brain death (26.6% vs 7.1% (Figure LI 51). Amid the ongoing opioid epidemic in the United States, the proportion of donors with anoxic brain injury continued to rise, representing the leading cause of death among deceased donors (46.3%) (Figure LI 52).

In 2020, 485 living donor liver transplants were performed, a 6% decrease compared with the year before (n=516), which was likely an effect of the COVID pandemic (Figure LI 54). Most donors were related to or directed to the recipient, with a small but growing proportion of nondirected living donation (12.0%) as well as paired donation (2.9%). Most living donors were 18 to 54 years old, with a minority being over 55 years (5.5%) (Figure LI 55). Living donors were more likely to be women (58.0%) and White (79.4%) (Figure LI 56, Figure LI 57). In most cases, the right lobe of the liver was used (76.2%), an overall increasing trend in the past decade (Figure LI 58). The readmission rate for living liver donors (2015-2019) was 9.0% at 6 months and 11.0% at 12 months (Figure LI 53). Reported events among liver donors (2016-2020) included biliary complications (2.6%), vascular complications requiring intervention (0.8%), reoperation (2.1%), and other complications requiring intervention (5.3%) (Table LI 6). Of these donors, 0.9% experienced Clavien Grade 1 complications, while 1.5% had Clavien Grade 2, and 0.4% had Clavien Grade 3 complications (Table LI 6).

Transplants

In 2020, despite the COVID-19 pandemic, 8906 liver transplants were performed in the United States, more than in any previous year (Figure LI 60, Figure LI 61). Adults represented 94.4% of liver transplant recipients, with 7979 deceased donor and 425 living donor liver transplants. The proportion of patients 65 years or older continued to grow, making up 22.4% (Figure LI 62). Among liver transplant recipients, 63.2% were male; 70.0% were White, 16.8% were Hispanic, 7.3% were Black, and 4.3% were Asian (Figure LI 63, Figure LI 64, Table LI 8). Coincident with the increased prevalence of nonalcoholic steatohepatitis, 39.3% were obese (BMI ≥30 kg/m2) (Table LI 8), and 28.9% had diabetes (Table LI 9). Compared with a decade before, a smaller proportion (4.3% vs 6.3%) of recipients had a prior liver transplant (Table LI 10). Half of adult liver transplants were covered by private insurance (50.8%), followed by Medicare (28.9%) and Medicaid (16.3%).

Among adults, alcohol-associated liver disease was the most common indication for liver transplant, surpassing the other/unknown category (often nonalcoholic steatohepatitis) (35.2% vs 34.6%) (Figure LI 65, Table LI 9). The proportion of liver transplant for HCV continued to fall, representing only 6.7% of transplants, from 26.6% in 2010. Liver transplants for HCC, the third most common diagnosis, declined further, to 12.6%, likely related to interim changes in the allocation of exception points and decreasing prevalence of patients with HCV infection at risk of HCC. With regard to medical urgency, 20.9% of adults received transplants with MELD ≥35, 18.3% with MELD 30-34, 52.0% with MELD 15-29, 6.4% with MELD <15, and 2.4% as status 1A (Table LI 9). The proportion of patients hospitalized at transplant was 37.2%, with 14.4% in the intensive care unit (Table LI 9). Waiting time was much shorter in 2020 than in prior years: 43.8% waited fewer than 31 days, while 68.6% waited fewer than 6 months, and 85.6% waited less than 1 year (Table LI 10).

Multiorgan transplants accounted for 10.1%, most of which were simultaneous liver-kidney transplants (9.1%) (Table LI 10). Very few adult recipients received split livers (0.8%). The proportion of patients receiving DCD livers continued to increase, up to 9.9%, compared with 4.6% in 2010 (Table LI 10). From 2018 to 2020, 9.7% of transplanted deceased donor livers carried HCV antibodies, with over half having negative HCV nucleic acid testing (Table LI 11).

Within the continental United States, geographic variability in organ availability may be measured in terms of median allocation MELD. Among adult deceased donor liver transplant recipients, the median MELD ranged from 18 to 33 by DSA (Figure LI 68). The median DSA-level MELD at transplant was 27, with an interquartile range of 24-29, a measure of spread among the DSAs, similar to 2019 (Figure LI 69). Although preliminary, these data suggest that the allocation changes employing acuity circles implemented early in 2020 did not have a measurable impact on reducing geographic variability among DSAs.

The National Liver Review Board was established in May 2019 to better standardize exceptions. The “point escalator” previously granted for qualifying candidates was replaced with a static score, for most, 3 points below the center’s median allocation MELD at transplant. In 2020, 22.5% of adult liver transplants were allocated by exception points, compared with 28.7% in 2019 and 34.3% in 2018 (Figure LI 126). This decline was driven by a decrease in non-HCC exceptions, which made up 5.4% of cases, compared with 10.3% in 2019 and 12.9% in 2018 (Table LI 9).

In 2020, 119 programs performed adult liver transplants, and the median transplant program volume increased from 55 in 2019 (IQR, 24-104) to 66 in 2020 (IQR, 24-101) (Figure LI 72). The bottom quartile of transplant centers in terms of volume performed fewer than 25 liver transplants, whereas the top quartile performed more than 100 liver transplants.

There were no noticeable changes in posttransplant immunosuppression. Induction therapy was used in 28.0% of adult liver transplants, and 71.6% of adult liver transplant recipients received steroid-containing immunosuppressive regimens (Figure LI 66, Figure LI 67).

Outcomes

As of June 30, 2020, 98842 liver transplant recipients were alive with a functioning graft, of whom 87030 received a liver transplant as adults (Figure LI 89).

Both short- and long-term outcomes after liver transplant continued to improve. Graft failure occurred in 5.9% of deceased donor liver transplant recipients at 6 months and 7.9% at 1 year for transplants performed in 2019, in 14.7% at 3 years for transplants in 2017, in 20.7% at 5 years for transplants in 2015, and in 40.6% at 10 years for transplants in 2010 (Figure LI 74). Outcomes were similar, if not better, for living donor liver transplant recipients, with graft failure occurring in 4.9% at 6 months, 7.4% at 1 year, 12.2% at 3 years, 23.7% at 5 years, and 36.7% at 10 years (Figure LI 75). Patient survival demonstrated similar patterns, with 4.6% mortality at 6 months, 6.4% at 1 year, 13.1% at 3 years, 18.8% at 5 years, and 38.2% at 10 years (Figure LI 76).

Five-year graft survival rates among deceased donor liver transplant recipients exceeded 75% across most categories, except for those ≥65 years (74.0%), MELD 40+ (74.5%), and DCD liver recipients (74.2%) (Figure LI 77, Figure LI 79, Figure LI 80). Five-year graft outcomes were equivalent between those with and without HCC exception points (Figure LI 81). Whereas deceased donor liver transplant recipients with a primary diagnosis of HCC had 5-year survival rates comparable to other disease etiologies (77.0%), living donor liver transplant recipients with HCC demonstrated worse 5-year survival rates (70.1%) (Figure LI 78, Figure LI 86). Patient outcomes after deceased donor and living donor liver transplant largely mirrored that of graft survival (Figure LI 93, Figure LI 94, Figure LI 95, Figure LI 97, Figure LI 98). Within 1 year, 11.5% of adult liver transplant recipients in 2018-2019 reported at least one episode of acute rejection, most often among recipients aged 18-34 (19.6%) (Figure LI 90). About 1% of adult liver recipients developed posttransplant lymphoproliferative disorder over 5 years; among Epstein-Barr virus-negative recipients, the incidence was doubled (Figure LI 92).

Pediatric Transplant

Summary

Pediatric liver transplant candidates were prioritized for pediatric donors as part of the acuity circles policy implemented in February 2020. This allowed offers to be prioritized to children nationally before being offered to adults within a 500 nautical mile acuity circle. In 2020, pediatric waitlist mortality decreased to its lowest rate since 2011, accounted for primarily by a decrease in waitlist mortality in infants <1 year old. Simultaneously, in 2020, adult waitlist pretransplant mortality rates continued to improve despite this change. Even though pretransplant mortality rates for children improved in 2020, 33 children still died on the waitlist or were removed for being too sick to transplant. The utilization of exception scores decreased between 2019 and 2020 and the number of technical variant liver transplants has not changed significantly over the last decade. Overall, living donor recipients have better long-term graft and patient survival compared to deceased donor recipients, but the proportion of recipients undergoing living donor transplant decreased in 2020 compared to 2019. While long-term patient survival continues to improve, 15.9% of pediatric liver transplant recipients transplanted in 2010 did not survive to 2020. Finally, addressing racial disparities in pediatric liver transplantation must remain forefront, with higher pretransplant mortality rates noted for Black, Hispanic and Asian registrants compared to White registrants.

Waiting List

In 2020, 616 new registrants were added to the pediatric liver transplant waiting list (Figure LI 102). Children <1 year (28.9%) and 1-5 years (28.8%) made up the largest age groups, followed by 12-17 (27.4%) and 6-11 years (14.8%) (Figure LI 104). White registrants continued to make up the largest racial/ethnic group on the waitlist in 2020 (45.4%), followed by Hispanic (26.2%), Black (17.6%), and Asian registrants (7.7%) (Figure LI 105). For pediatric liver waitlist registrants, between 2010 to 2020, sex, race, diagnosis, and geographic distributions did not change substantially (Table LI 13, Table LI 14).

Waiting time has not changed significantly in the past decade with 54.4% of candidates waiting less than 1 year in 2020, 15.3% waiting 1-2 years and 30.3% waiting 2 or more years until transplant (Table LI 15). The proportion of registrants listed for multi-organ transplant continues to increase over the last decade: liver-kidney registrants increased from 1.5% to 3.8%, liver-pancreas-intestine registrants from 8.3% to 13.8% and liver-heart registrants from 0.2% to 1.5% (Table LI 15). Among registrants removed from the waitlist in 2020: 67.4% underwent deceased donor transplant and 9.8% underwent living donor transplant. In 2020, fewer registrants died on the waitlist (n=17, 2.5%) compared to 2019 (n=29, 3.9%), 11.0% were removed because their condition improved, and 2.4% were considered too sick for transplant (Table LI 17).

Pretransplant mortality decreased to its lowest rate since 2011 at 4.9 deaths per 100 waitlist-years in 2020 accounted for primarily by a decrease in mortality rate for infants less than 1 year old; from 12.1 to 6.4 deaths per 100 waitlist-years between 2019 and 2020 (Figures LI 114 and 115). However, 17 registrants still died on the waitlist and 16 were too sick to transplant in 2020 (Table LI 17). While the pretransplant mortality rate remained the highest for registrants younger than 1 year, the gap narrowed in 2020 with the next highest pretransplant mortality rate being 5.7 deaths per 100 waitlist-years for 6-11 year olds (Figure LI 115). Pretransplant mortality rates were highest in Asian followed by Black and Hispanic registrants with the lowest mortality rate for White registrants (Figure LI 116).

Transplants

In 2020, 502 pediatric liver transplants were performed in the United States, the lowest number in the past decade and a decrease of 8.9% from 2019 (Figure LI 118). The overall number of pediatric transplants decreased for 0-11 year olds, but increased for 12-17 year olds (Figure LI 120). Recipient demographics including age at the time of transplant, race or ethnicity, insurance type and geography have remained similar over the past decade (Table LI 18). Biliary atresia remaining the leading indication for transplant (33.2%) followed by other/unknown diagnosis (21.6%), metabolic (17.3%), other cholestatic condition (13.1%), acute liver failure (7.7%) and hepatoblastoma (7.1%) (Table LI 19). From 2018-2020, 5.6% (n=90) of recipients received an ABO incompatible graft and 0.3% (n=5) received a graft from a donor after circulatory death. The majority of recipients were liver only transplants (91.8%), followed by liver-intestine-pancreas (4%), liver-kidney (3.2%) and liver-intestine (0.2%) (Table LI 20).

Sixty-one percent of recipients between 0-17 years old had an exception PELD or MELD score at the time of transplant, decreasing from 74.7% the year prior (Figure LI 126). The utilization of exception scores continued to vary by donation service area ranging from 20-100% of transplanted recipients (Figure LI 127). Over the last decade, there has been no change in living donor transplants and fewer total recipients underwent living donor transplant in 2020 (n=66, 12.7% of total transplants) compared to 2019 (n=82, 14.5% of total transplants). Over the last decade there has been some shift from living related donors to more unrelated and non-directed (altruistic) living donors (Table LI 17, Figure LI 121). There has been no increase in the use of technical variant grafts over the last decade and in 2020 63.1% were whole liver transplants, 19.9% were partial liver and 16.9% were split liver transplants (Figure LI 125). Fewer patients were transplanted for acute liver failure and more patients were transplanted for metabolic conditions in 2018-2020 compared to 2008-2010. This is also reflected in fewer patients being transplanted at Status 1A and more patients being transplanted at Status 1B over the last decade. The plurality of recipients (43.8%) were transplanted at a MELD/PELD 30 (Table LI 19).

In 2020, 63.5% of pediatric liver transplant recipients received no induction therapy (Figure LI 128). The most common initial immunosuppression regimens were tacrolimus, MMF, and steroids (38.6%) and tacrolimus and steroids (36.9%) (Figure LI 129).

Outcomes

Within 1 year of transplant, 26% of transplant recipients in 2018-2019 had at least one episode of rejection (Figure LI 137). By 5 years out from transplant 4.2% of recipients developed posttransplant lymphoproliferative disorder (Figure LI 138).

Graft failure occurred in 7.6% of deceased donor recipients at 6 months, 9.3% at 1 year, 11.6% at 3 years, 14.2% at 5 years, and 20.9% at 10 years from transplant (Figure LI 131). Graft failure was generally lower in living donor recipients, occurring in 3.8% at 6 months, 7.6% at 1 year, 5.6% at 3 years, 8.9% at 5 years and 25.4% at 10 years out from transplant (Figure LI 132). Five-year graft survival was highest for recipients who were 6-11 years old at the time of transplant (88.8%) followed by 12-17 (86.3%), <1 year (83.5%) and 1-5 year olds (80.7%) for deceased donor recipients (Figure LI 133). By diagnosis, five-year graft survival was highest for deceased donor recipients with biliary atresia (87.5%), followed by metabolic conditions (86.3%), acute liver failure (83.9%), other/unknown (81.2%), other cholestatic (80.4%) and hepatoblastoma (77.7%) (Figure LI 134). Deceased donor recipients transplanted at a PELD/MELD between 35-39 had the lowest five-year graft survival at 72.9% (Figure LI 135). At all time points, living donor recipients had better graft survival compared to deceased donor recipients, with a five-year graft survival of 90.1% compared to 83.8%, respectively (Figure LI 136)

Recipient mortality continued to improve over the last decade, though still remains notable. Death occurred in 3.8% of deceased and living donor recipients at 6 months, 5.6% at 1 year, 8.5% at 3 years, 9.1% at 5 years, and 15.9% at 10 years from transplant (Figure LI 139). Five-year patient survival was highest for recipients who were 6-11 years old at the time of transplant (92.0%) followed by <1 year (91.5%), 12-17 (89.4%) and 1-5 year olds (88.4%) for deceased donor recipients (Figure LI 141). By diagnosis, five-year patient survival was highest for deceased donor recipients with biliary atresia (93.5%), followed by acute liver failure (92.9%), metabolic conditions (92.1%), other/unknown (87.1%), other cholestatic (85.7%) and hepatoblastoma (82.6%) (Figure LI 142). At all time points, living donor recipients had better patient survival compared to deceased donor recipients, with a five-year patient survival of 93.6% compared to 89.9%, respectively (Figure LI 143).

Figure List

Waiting list

Figure LI 1. New adult candidates added to the liver transplant waiting list
Figure LI 2. All adult candidates on the liver transplant waiting list
Figure LI 3. Distribution of adults waiting for liver transplant by age
Figure LI 4. Distribution of adults waiting for liver transplant by sex
Figure LI 5. Distribution of adults waiting for liver transplant by race
Figure LI 6. Distribution of adults waiting for liver transplant by diagnosis
Figure LI 7. Distribution of adults waiting for liver transplant by first active lab MELD in the year
Figure LI 8. Distribution of adults waiting for liver transplant by BMI
Figure LI 9. Distribution of adults waiting for liver transplant by blood type
Figure LI 10. Distribution of adults waiting for liver transplant by prior transplant status
Figure LI 11. Adults willing to accept liver from HCV+ donor
Figure LI 12. Overall deceased donor liver transplant rates among adult waitlist candidates
Figure LI 13. Deceased donor liver transplant rates among adult waitlist candidates by age
Figure LI 14. Deceased donor liver transplant rates among adult waitlist candidates by race
Figure LI 15. Deceased donor liver transplant rates among adult waitlist candidates by blood type
Figure LI 16. Deceased donor liver transplant rates among adult waitlist candidates by HCC exception status
Figure LI 17. Deceased donor liver transplant rates among adult waitlist candidates by sex
Figure LI 18. Deceased donor liver transplant rates among adult waitlist candidates by metropolitan vs. non-metropolitan residence
Figure LI 19. Three-year outcomes for adults waiting for liver transplant, new listings in 2015-2017
Figure LI 20. Median months to liver transplant for waitlisted adults
Figure LI 21. Percentage of adults who underwent deceased donor liver transplant within a given time period of listing
Figure LI 22. Percentage of adults who underwent deceased donor liver transplant within 3 years of listing, 2017, by DSA
Figure LI 23. Percentage of adults who underwent deceased donor liver transplant within 3 years of listing, 2017, by state
Figure LI 24. Overall pretransplant mortality rates among adults waitlisted for liver transplant
Figure LI 25. Pretransplant mortality rates among adults waitlisted for liver transplant by age
Figure LI 26. Pretransplant mortality rates among adults waitlisted for liver transplant by race
Figure LI 27. Pretransplant mortality rates among adults waitlisted for liver transplant by sex
Figure LI 28. Pretransplant mortality rates among adults waitlisted for liver transplant by diagnosis
Figure LI 29. Pretransplant mortality rates among adults waitlisted for liver transplant by metropolitan vs. non-metropolitan residence
Figure LI 30. Pretransplant mortality rates among adults waitlisted for liver transplant by first active lab MELD in the year
Figure LI 31. Pretransplant mortality rates among adults waitlisted for liver by HCC exception status
Figure LI 32. Pretransplant mortality rates among adults waitlisted for liver transplant in 2020 by DSA
Figure LI 33. Deaths within six months after removal among adult liver waitlist candidates, overall
Figure LI 34. Deaths within six months after removal among adult liver waitlist candidates, by first active lab MELD in the year
Figure LI 35. Deaths within six months after removal among adult liver waitlist candidates, by age

Deceased donation

Figure LI 36. Overall deceased liver donor count
Figure LI 37. Deceased liver donor count by age
Figure LI 38. Deceased liver donor count by HCV status
Figure LI 39. Distribution of deceased liver donors by age
Figure LI 40. Distribution of deceased liver donors by sex
Figure LI 41. Distribution of deceased liver donors by race
Figure LI 42. Distribution of deceased liver donors by donor HCV status
Figure LI 43. Percent of pediatric donor livers allocated to adult recipients, by DSA of donor hospital, 2016-2020
Figure LI 44. Overall percent of livers recovered for transplant and not transplanted
Figure LI 45. Percent of livers recovered for transplant and not transplanted by donor age
Figure LI 46. Percent of livers recovered for transplant and not transplanted by donor sex
Figure LI 47. Percent of livers recovered for transplant and not transplanted by donor race
Figure LI 48. Percent of livers recovered for transplant and not transplanted by donor cause of death
Figure LI 49. Percent of livers recovered for transplant and not transplanted by donor HCV status
Figure LI 50. Percent of livers recovered for transplant and not transplanted, by donor risk of disease transmission
Figure LI 51. Percent of livers recovered for transplant and not transplanted by DCD status
Figure LI 52. Cause of death among deceased liver donors

Living donation

Figure LI 53. Rehospitalization among living liver donors, 2015-2019
Figure LI 54. Number of living liver transplants by donor relation
Figure LI 55. Living liver donors by age
Figure LI 56. Living liver donors by sex
Figure LI 57. Living liver donors by race
Figure LI 58. Living donor liver transplant graft type
Figure LI 59. BMI among living liver donors

Transplant

Figure LI 60. Overall liver transplants
Figure LI 61. Total liver transplants by donor type
Figure LI 62. Total liver transplants by age
Figure LI 63. Total liver transplants by sex
Figure LI 64. Total liver transplants by race
Figure LI 65. Total liver transplants by diagnosis
Figure LI 66. Induction agent use in adult liver transplant recipients
Figure LI 67. Immunosuppression regimen use in adult liver transplant recipients
Figure LI 68. Median MELD scores for adult deceased donor liver transplant recipients by DSA, 2020
Figure LI 69. Quartiles of median MELD at transplant across DSAs for adult deceased donor liver recipients.
Figure LI 70. Percent of adult liver transplant recipients using exceptions in 2020, by DSA
Figure LI 71. Total HLA A, B, and DR mismatches among adult deceased donor liver-kidney transplant recipients, 2016-2020
Figure LI 72. Annual adult liver transplant center volumes by percentile
Figure LI 73. Distribution of adult liver transplants by annual center volume

Outcomes

Figure LI 74. Graft failure among adult deceased donor liver transplant recipients
Figure LI 75. Graft failure among adult living donor liver transplant recipients
Figure LI 76. Patient death among adult liver transplant recipients
Figure LI 77. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by age
Figure LI 78. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by diagnosis
Figure LI 79. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by lab MELD
Figure LI 80. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by DCD status
Figure LI 81. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by HCC status
Figure LI 82. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by BMI
Figure LI 83. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by metropolitan vs. non-metropolitan recipient residence
Figure LI 84. Graft survival among adult living donor liver transplant recipients, 2013-2015, by age
Figure LI 85. Graft survival among adult living donor liver transplant recipients, 2013-2015, by race
Figure LI 86. Graft survival among adult living donor liver transplant recipients, 2013-2015, by diagnosis
Figure LI 87. Graft survival among adult living donor liver transplant recipients, 2013-2015, by lab MELD
Figure LI 88. Graft survival among adult living donor liver transplant recipients, 2013-2015, by metropolitan vs. non-metropolitan recipient residence
Figure LI 89. Recipients alive with a functioning liver graft on June 30 of the year, by age at transplant
Figure LI 90. Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by age, 2018-2019
Figure LI 91. Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by induction agent, 2018-2019
Figure LI 92. Incidence of PTLD among adult liver transplant recipients by recipient EBV status at transplant, 2014-2018
Figure LI 93. Patient survival among adult deceased donor liver transplant recipients, 2013-2015, by age
Figure LI 94. Patient survival among adult deceased donor liver transplant recipients, 2013-2015, by diagnosis
Figure LI 95. Patient survival among adult deceased donor liver transplant recipients, 2013-2015, by medical urgency
Figure LI 96. Patient survival among adult deceased donor liver transplant recipients, 2013-2015, by metropolitan vs. non-metropolitan recipient residence
Figure LI 97. Patient survival among adult living donor liver transplant recipients, 2013-2015, by age
Figure LI 98. Patient survival among adult living donor liver transplant recipients, 2013-2015, by diagnosis
Figure LI 99. Patient survival among adult living donor liver transplant recipients, 2013-2015, by race
Figure LI 100. Patient survival among adult living donor liver transplant recipients, 2013-2015, by MELD score
Figure LI 101. Patient survival among adult living donor liver transplant recipients, 2013-2015, by metropolitan vs. non-metropolitan recipient residence

Pediatric transplant

Figure LI 102. New pediatric candidates added to the liver transplant waiting list
Figure LI 103. All pediatric candidates on the liver transplant waiting list
Figure LI 104. Distribution of pediatric candidates waiting for liver transplant by age
Figure LI 105. Distribution of pediatric candidates waiting for liver transplant by race
Figure LI 106. Distribution of pediatric candidates waiting for liver transplant by sex
Figure LI 107. Three-year outcomes for newly listed pediatric candidates waiting for liver transplant, 2015-2017
Figure LI 108. Overall deceased donor liver transplant rates among pediatric waitlist candidates
Figure LI 109. Deceased donor liver transplant rates among pediatric waitlist candidates by age
Figure LI 110. Deceased donor liver transplant rates among pediatric waitlist candidates by race
Figure LI 111. Deceased donor liver transplant rates among pediatric waitlist candidates by allocation MELD/PELD
Figure LI 112. Deceased donor liver transplant rates among pediatric waitlist candidates by Status 1A or 1B
Figure LI 113. Deceased donor liver transplant rates among pediatric waitlist candidates by metropolitan vs. non-metropolitan residence
Figure LI 114. Overall pretransplant mortality rates among pediatric candidates waitlisted for liver
Figure LI 115. Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by age
Figure LI 116. Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by race
Figure LI 117. Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by metropolitan vs. non-metropolitan residence
Figure LI 118. Overall pediatric liver transplants
Figure LI 119. Pediatric liver transplants by donor type
Figure LI 120. Pediatric liver transplants by recipient age
Figure LI 121. Pediatric liver transplants from living donors by relation
Figure LI 122. Percent of pediatric liver transplants from living donors by recipient age
Figure LI 123. Number of centers performing pediatric and adult liver transplants by center's age mix
Figure LI 124. Pediatric liver recipients at programs that perform 5 or fewer pediatric transplants annually
Figure LI 125. Split or partial liver transplants in children
Figure LI 126. Percent of pediatric and adult liver transplant recipients allocated by exception
Figure LI 127. Percent of pediatric liver transplant recipients using exceptions, 2018-2020, by DSA
Figure LI 128. Induction agent use in pediatric liver transplant recipients
Figure LI 129. Immunosuppression regimen use in pediatric liver transplant recipients
Figure LI 130. Total HLA A, B, and DR mismatches among pediatric deceased donor liver-kidney transplant recipients, 2015-2019
Figure LI 131. Graft failure among pediatric deceased donor liver transplant recipients
Figure LI 132. Graft failure among pediatric living donor liver transplant recipients
Figure LI 133. Graft survival among pediatric deceased donor liver transplant recipients, 2013-2015, by age
Figure LI 134. Graft survival among pediatric deceased donor liver transplant recipients, 2013-2015, by diagnosis
Figure LI 135. Graft survival among pediatric deceased donor liver transplant recipients, 2013-2015, by lab MELD/PELD score
Figure LI 136. Graft survival among pediatric liver transplant recipients, 2013-2015, by donor type
Figure LI 137. Incidence of acute rejection by 1 year posttransplant among pediatric liver transplant recipients by age, 2018-2019
Figure LI 138. Incidence of PTLD among pediatric liver transplant recipients by recipient EBV status at transplant, 2008-2018
Figure LI 139. Patient death among pediatric liver transplant recipients
Figure LI 140. Overall patient survival among pediatric deceased donor liver transplant recipients, 2013-2015
Figure LI 141. Patient survival among pediatric deceased donor liver transplant recipients, 2013-2015, by recipient age
Figure LI 142. Patient survival among pediatric deceased donor liver transplant recipients, 2013-2015, by diagnosis
Figure LI 143. Patient survival among pediatric liver transplant recipients, 2013-2015, by donor type

Table List

Waiting list

Table LI 1. Demographic characteristics of adults on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Table LI 2. Clinical characteristics of adults on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Table LI 3. Listing characteristics of adults on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Table LI 4. Liver transplant waitlist activity among adults
Table LI 5. Removal reason among adult liver transplant candidates

Living donation

Table LI 6. Complications among living liver donors, 2016-2020
Table LI 7. Living liver donor deaths in the first year after donoation, 2016-2020, by number of days after donation

Transplant

Table LI 8. Demographic characteristics of adult liver transplant recipients, 2010 and 2020
Table LI 9. Clinical characteristics of adult liver transplant recipients, 2010 and 2020
Table LI 10. Transplant characteristics of adult liver transplant recipients, 2010 and 2020
Table LI 11. Adult deceased donor liver donor-recipient serology matching, 2018-2020
Table LI 12. Adult living donor liver donor-recipient serology matching, 2018-2020

Pediatric transplant

Table LI 13. Demographic characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Table LI 14. Clinical characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Table LI 15. Listing characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Table LI 16. Liver transplant waitlist activity among pediatric candidates
Table LI 17. Removal reason among pediatric liver transplant candidates
Table LI 18. Demographic characteristics of pediatric liver transplant recipients, 2008-2010 and 2018-2020
Table LI 19. Clinical characteristics of pediatric liver transplant recipients, 2008-2010 and 2018-2020
Table LI 20. Transplant characteristics of pediatric liver transplant recipients, 2008-2010 and 2018-2020
Table LI 21. Pediatric liver donor-recipient serology matching, 2018-2020
Table LI 22. Pediatric liver donor-recipient serology matching for living donors, 2018-2020

A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included.

Figure LI 1. New adult candidates added to the liver transplant waiting list
A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included.


Adult candidates on the list at any time during the year. Candidates listed at more than one center are counted once per listing.

Figure LI 2. All adult candidates on the liver transplant waiting list
Adult candidates on the list at any time during the year. Candidates listed at more than one center are counted once per listing.


Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.

Figure LI 3. Distribution of adults waiting for liver transplant by age
Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.


Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LI 4. Distribution of adults waiting for liver transplant by sex
Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.


Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LI 5. Distribution of adults waiting for liver transplant by race
Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.


Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LI 6. Distribution of adults waiting for liver transplant by diagnosis
Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.


Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LI 7. Distribution of adults waiting for liver transplant by first active lab MELD in the year
Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.


Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LI 8. Distribution of adults waiting for liver transplant by BMI
Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.


Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LI 9. Distribution of adults waiting for liver transplant by blood type
Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.


Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LI 10. Distribution of adults waiting for liver transplant by prior transplant status
Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.


Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Willingness to accept HCV+ organ at time of listing. HCV, hepatitus C virus.

Figure LI 11. Adults willing to accept liver from HCV+ donor
Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Willingness to accept HCV+ organ at time of listing. HCV, hepatitus C virus.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

Figure LI 12. Overall deceased donor liver transplant rates among adult waitlist candidates
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

Figure LI 13. Deceased donor liver transplant rates among adult waitlist candidates by age
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

Figure LI 14. Deceased donor liver transplant rates among adult waitlist candidates by race
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

Figure LI 15. Deceased donor liver transplant rates among adult waitlist candidates by blood type
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

Figure LI 16. Deceased donor liver transplant rates among adult waitlist candidates by HCC exception status
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

Figure LI 17. Deceased donor liver transplant rates among adult waitlist candidates by sex
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Urban/rural determination is made using the RUCA (Rural-Urban Commuting Area) designation of the candidate

Figure LI 18. Deceased donor liver transplant rates among adult waitlist candidates by metropolitan vs. non-metropolitan residence
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Urban/rural determination is made using the RUCA (Rural-Urban Commuting Area) designation of the candidate's permanent zip code.


Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor; LD, living donor.

Figure LI 19. Three-year outcomes for adults waiting for liver transplant, new listings in 2015-2017
Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor; LD, living donor.


Observations censored on December 31, 2020; Kaplan-Meier competing risk methods used to estimate time to transplant. Analysis performed per listing. If an estimate is not plotted, 50% of the cohort listed in that year had not undergone transplant by the censoring date. Only the first transplant is counted.

Figure LI 20. Median months to liver transplant for waitlisted adults
Observations censored on December 31, 2020; Kaplan-Meier competing risk methods used to estimate time to transplant. Analysis performed per listing. If an estimate is not plotted, 50% of the cohort listed in that year had not undergone transplant by the censoring date. Only the first transplant is counted.


Candidates listed at more than one center are counted once per listing.

Figure LI 21. Percentage of adults who underwent deceased donor liver transplant within a given time period of listing
Candidates listed at more than one center are counted once per listing.


Candidates listed at more than one center are counted once per listing.

Figure LI 22. Percentage of adults who underwent deceased donor liver transplant within 3 years of listing, 2017, by DSA
Candidates listed at more than one center are counted once per listing.


Candidates listed at more than one center are counted once per listing. State is candidate

Figure LI 23. Percentage of adults who underwent deceased donor liver transplant within 3 years of listing, 2017, by state
Candidates listed at more than one center are counted once per listing. State is candidate's home state.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LI 24. Overall pretransplant mortality rates among adults waitlisted for liver transplant
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LI 25. Pretransplant mortality rates among adults waitlisted for liver transplant by age
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LI 26. Pretransplant mortality rates among adults waitlisted for liver transplant by race
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LI 27. Pretransplant mortality rates among adults waitlisted for liver transplant by sex
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease.

Figure LI 28. Pretransplant mortality rates among adults waitlisted for liver transplant by diagnosis
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (Rural-Urban Commuting Area) designation of the candidate

Figure LI 29. Pretransplant mortality rates among adults waitlisted for liver transplant by metropolitan vs. non-metropolitan residence
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (Rural-Urban Commuting Area) designation of the candidate's permanent zip code.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date and January 1 of the year.

Figure LI 30. Pretransplant mortality rates among adults waitlisted for liver transplant by first active lab MELD in the year
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date and January 1 of the year.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LI 31. Pretransplant mortality rates among adults waitlisted for liver by HCC exception status
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LI 32. Pretransplant mortality rates among adults waitlisted for liver transplant in 2020 by DSA
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.


Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure LI 33. Deaths within six months after removal among adult liver waitlist candidates, overall
Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.


Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure LI 34. Deaths within six months after removal among adult liver waitlist candidates, by first active lab MELD in the year
Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.


Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure LI 35. Deaths within six months after removal among adult liver waitlist candidates, by age
Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.


Count of deceased donors whose livers were recovered for transplant.

Figure LI 36. Overall deceased liver donor count
Count of deceased donors whose livers were recovered for transplant.


Count of deceased donors whose livers were recovered for transplant.

Figure LI 37. Deceased liver donor count by age
Count of deceased donors whose livers were recovered for transplant.


Count of deceased donors whose livers were recovered for transplant. Donor HCV status was based on an antibody test.

Figure LI 38. Deceased liver donor count by HCV status
Count of deceased donors whose livers were recovered for transplant. Donor HCV status was based on an antibody test.


Deceased donors whose livers were recovered for transplant.

Figure LI 39. Distribution of deceased liver donors by age
Deceased donors whose livers were recovered for transplant.


Deceased donors whose livers were recovered for transplant.

Figure LI 40. Distribution of deceased liver donors by sex
Deceased donors whose livers were recovered for transplant.


Deceased donors whose livers were recovered for transplant.

Figure LI 41. Distribution of deceased liver donors by race
Deceased donors whose livers were recovered for transplant.


Deceased donors whose livers were recovered for transplant. Donor HCV status was based on an antibody test.

Figure LI 42. Distribution of deceased liver donors by donor HCV status
Deceased donors whose livers were recovered for transplant. Donor HCV status was based on an antibody test.


Numerator: pediatric donor livers donors allocated to adult recipients. Denominator: total pediatric donor livers.

Figure LI 43. Percent of pediatric donor livers allocated to adult recipients, by DSA of donor hospital, 2016-2020
Numerator: pediatric donor livers donors allocated to adult recipients. Denominator: total pediatric donor livers.



Percentages of livers not transplanted out of all livers recovered for transplant.

Figure LI 44. Overall percent of livers recovered for transplant and not transplanted
Percentages of livers not transplanted out of all livers recovered for transplant.



Percentages of livers not transplanted out of all livers recovered for transplant.

Figure LI 45. Percent of livers recovered for transplant and not transplanted by donor age
Percentages of livers not transplanted out of all livers recovered for transplant.



Percentages of livers not transplanted out of all livers recovered for transplant.

Figure LI 46. Percent of livers recovered for transplant and not transplanted by donor sex
Percentages of livers not transplanted out of all livers recovered for transplant.



Percentages of livers not transplanted out of all livers recovered for transplant.

Figure LI 47. Percent of livers recovered for transplant and not transplanted by donor race
Percentages of livers not transplanted out of all livers recovered for transplant.


Percentages of livers not transplanted out of all livers recovered for transplant. CVA, cerebrovascular accident.

Figure LI 48. Percent of livers recovered for transplant and not transplanted by donor cause of death
Percentages of livers not transplanted out of all livers recovered for transplant. CVA, cerebrovascular accident.


Percentages of livers not transplanted out of all livers recovered for transplant. Donor HCV status was based on an antibody test.

Figure LI 49. Percent of livers recovered for transplant and not transplanted by donor HCV status
Percentages of livers not transplanted out of all livers recovered for transplant. Donor HCV status was based on an antibody test.


Percentages of livers not transplanted out of all livers recovered for transplant.  "Increased risk" is defined by criteria from the US Public Health Service Guidelines for increased risk for HIV, hepatitis B and hepatitis C transmission.

Figure LI 50. Percent of livers recovered for transplant and not transplanted, by donor risk of disease transmission
Percentages of livers not transplanted out of all livers recovered for transplant. "Increased risk" is defined by criteria from the US Public Health Service Guidelines for increased risk for HIV, hepatitis B and hepatitis C transmission.



Percentages of livers not transplanted out of all livers recovered for transplant. DBD, donation after brain death; DCD, donation after circulatory death.

Figure LI 51. Percent of livers recovered for transplant and not transplanted by DCD status
Percentages of livers not transplanted out of all livers recovered for transplant. DBD, donation after brain death; DCD, donation after circulatory death.


Deceased donors with a liver recovered for the purposes of transplant. CVA, cerebrovascular accident.

Figure LI 52. Cause of death among deceased liver donors
Deceased donors with a liver recovered for the purposes of transplant. CVA, cerebrovascular accident.


Cumulative hospital readmission. Thedischarge time point is recorded at the earliest of discharge or 6 weeks after donation. Domino liver donors excluded.

Figure LI 53. Rehospitalization among living liver donors, 2015-2019
Cumulative hospital readmission. Thedischarge time point is recorded at the earliest of discharge or 6 weeks after donation. Domino liver donors excluded.


Numbers of living donor donations, excluding domino livers, as reported on the OPTN Living Donor Registration Form.

Figure LI 54. Number of living liver transplants by donor relation
Numbers of living donor donations, excluding domino livers, as reported on the OPTN Living Donor Registration Form.


As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.

Figure LI 55. Living liver donors by age
As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.


As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.

Figure LI 56. Living liver donors by sex
As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.


As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.

Figure LI 57. Living liver donors by race
As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.


As reported on the OPTN Living Donor Registration Form.

Figure LI 58. Living donor liver transplant graft type
As reported on the OPTN Living Donor Registration Form.


Donor height and weight reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.

Figure LI 59. BMI among living liver donors
Donor height and weight reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.


All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.

Figure LI 60. Overall liver transplants
All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.

Figure LI 61. Total liver transplants by donor type
All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.

Figure LI 62. Total liver transplants by age
All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.

Figure LI 63. Total liver transplants by sex
All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.

Figure LI 64. Total liver transplants by race
All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease; HCC, hepatocellular carcinoma.

Figure LI 65. Total liver transplants by diagnosis
All liver transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease; HCC, hepatocellular carcinoma.


Immunosuppression at transplant reported to the OPTN.

Figure LI 66. Induction agent use in adult liver transplant recipients
Immunosuppression at transplant reported to the OPTN.


Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, all mycophenolate agents.

Figure LI 67. Immunosuppression regimen use in adult liver transplant recipients
Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, all mycophenolate agents.


Deceased donor liver transplants. DSA of transplant center location. Status 1A and inactive status excluded; allocation MELD score used.

Figure LI 68. Median MELD scores for adult deceased donor liver transplant recipients by DSA, 2020
Deceased donor liver transplants. DSA of transplant center location. Status 1A and inactive status excluded; allocation MELD score used.


Deceased donor liver transplants, excluding Status 1A. Annual quartiles of DSA-level median allocation MELD scores are given, using DSA where the transplant center is located.

Figure LI 69. Quartiles of median MELD at transplant across DSAs for adult deceased donor liver recipients.
Deceased donor liver transplants, excluding Status 1A. Annual quartiles of DSA-level median allocation MELD scores are given, using DSA where the transplant center is located.


Exceptions among those allocated by MELD. Denominator excludes status 1A recipients.

Figure LI 70. Percent of adult liver transplant recipients using exceptions in 2020, by DSA
Exceptions among those allocated by MELD. Denominator excludes status 1A recipients.


Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2018. Limited to deceased donor liver-kidney transplants only.

Figure LI 71. Total HLA A, B, and DR mismatches among adult deceased donor liver-kidney transplant recipients, 2016-2020
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2018. Limited to deceased donor liver-kidney transplants only.


Annual volume data are limited to recipients aged 18 years or older.

Figure LI 72. Annual adult liver transplant center volumes by percentile
Annual volume data are limited to recipients aged 18 years or older.


Based on annual volume data among recipients aged 18 or older.

Figure LI 73. Distribution of adult liver transplants by annual center volume
Based on annual volume data among recipients aged 18 or older.


All adult recipients of deceased donor livers, including multi-organ transplants.

Figure LI 74. Graft failure among adult deceased donor liver transplant recipients
All adult recipients of deceased donor livers, including multi-organ transplants.


All adult recipients of living donor livers, including multi-organ transplants.

Figure LI 75. Graft failure among adult living donor liver transplant recipients
All adult recipients of living donor livers, including multi-organ transplants.


All adult recipients of deceased donor livers, including multi-organ transplants.

Figure LI 76. Patient death among adult liver transplant recipients
All adult recipients of deceased donor livers, including multi-organ transplants.


Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 77. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by age
Graft survival estimated using unadjusted Kaplan-Meier methods.


Graft survival estimated using unadjusted Kaplan-Meier methods. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease;.

Figure LI 78. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by diagnosis
Graft survival estimated using unadjusted Kaplan-Meier methods. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease;.


Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 79. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by lab MELD
Graft survival estimated using unadjusted Kaplan-Meier methods.


Graft survival estimated using unadjusted Kaplan-Meier methods. DCD, donation after circulatory death; DBD, donation after brain death.

Figure LI 80. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by DCD status
Graft survival estimated using unadjusted Kaplan-Meier methods. DCD, donation after circulatory death; DBD, donation after brain death.


Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 81. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by HCC status
Graft survival estimated using unadjusted Kaplan-Meier methods.


Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 82. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by BMI
Graft survival estimated using unadjusted Kaplan-Meier methods.


Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 83. Graft survival among adult deceased donor liver transplant recipients, 2013-2015, by metropolitan vs. non-metropolitan recipient residence
Graft survival estimated using unadjusted Kaplan-Meier methods.


Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 84. Graft survival among adult living donor liver transplant recipients, 2013-2015, by age
Graft survival estimated using unadjusted Kaplan-Meier methods.


Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 85. Graft survival among adult living donor liver transplant recipients, 2013-2015, by race
Graft survival estimated using unadjusted Kaplan-Meier methods.


Graft survival estimated using unadjusted Kaplan-Meier methods. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease;.

Figure LI 86. Graft survival among adult living donor liver transplant recipients, 2013-2015, by diagnosis
Graft survival estimated using unadjusted Kaplan-Meier methods. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease;.


Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 87. Graft survival among adult living donor liver transplant recipients, 2013-2015, by lab MELD
Graft survival estimated using unadjusted Kaplan-Meier methods.


Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 88. Graft survival among adult living donor liver transplant recipients, 2013-2015, by metropolitan vs. non-metropolitan recipient residence
Graft survival estimated using unadjusted Kaplan-Meier methods.


Recipients are assumed to be alive with function unless a death or graft failure is recorded. A recipient may experience a graft failure and be removed from the cohort, undergo retransplant, and re-enter the cohort.

Figure LI 89. Recipients alive with a functioning liver graft on June 30 of the year, by age at transplant
Recipients are assumed to be alive with function unless a death or graft failure is recorded. A recipient may experience a graft failure and be removed from the cohort, undergo retransplant, and re-enter the cohort.


Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

Figure LI 90. Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by age, 2018-2019
Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.


Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method. IL2-RA, interleukin-2 receptor agonist; TCD, T-cell depleting.

Figure LI 91. Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by induction agent, 2018-2019
Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method. IL2-RA, interleukin-2 receptor agonist; TCD, T-cell depleting.


Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin

Figure LI 92. Incidence of PTLD among adult liver transplant recipients by recipient EBV status at transplant, 2014-2018
Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.


Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 93. Patient survival among adult deceased donor liver transplant recipients, 2013-2015, by age
Patient survival estimated using unadjusted Kaplan-Meier methods.


Patient survival estimated using unadjusted Kaplan-Meier methods. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease.

Figure LI 94. Patient survival among adult deceased donor liver transplant recipients, 2013-2015, by diagnosis
Patient survival estimated using unadjusted Kaplan-Meier methods. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease.


Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 95. Patient survival among adult deceased donor liver transplant recipients, 2013-2015, by medical urgency
Patient survival estimated using unadjusted Kaplan-Meier methods.


Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 96. Patient survival among adult deceased donor liver transplant recipients, 2013-2015, by metropolitan vs. non-metropolitan recipient residence
Patient survival estimated using unadjusted Kaplan-Meier methods.


Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 97. Patient survival among adult living donor liver transplant recipients, 2013-2015, by age
Patient survival estimated using unadjusted Kaplan-Meier methods.


Patient survival estimated using unadjusted Kaplan-Meier methods. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease.

Figure LI 98. Patient survival among adult living donor liver transplant recipients, 2013-2015, by diagnosis
Patient survival estimated using unadjusted Kaplan-Meier methods. HCV, hepatitis C virus; ALD, alcoholic liver disease; Chol. disease, cholestatic disease.


Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 99. Patient survival among adult living donor liver transplant recipients, 2013-2015, by race
Patient survival estimated using unadjusted Kaplan-Meier methods.


Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 100. Patient survival among adult living donor liver transplant recipients, 2013-2015, by MELD score
Patient survival estimated using unadjusted Kaplan-Meier methods.


Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 101. Patient survival among adult living donor liver transplant recipients, 2013-2015, by metropolitan vs. non-metropolitan recipient residence
Patient survival estimated using unadjusted Kaplan-Meier methods.


A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LI 102. New pediatric candidates added to the liver transplant waiting list
A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.


Pediatric candidates listed at any time during the year. Candidates listed at more than one center are counted once per listing.

Figure LI 103. All pediatric candidates on the liver transplant waiting list
Pediatric candidates listed at any time during the year. Candidates listed at more than one center are counted once per listing.


Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.

Figure LI 104. Distribution of pediatric candidates waiting for liver transplant by age
Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.


Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.

Figure LI 105. Distribution of pediatric candidates waiting for liver transplant by race
Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.


Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LI 106. Distribution of pediatric candidates waiting for liver transplant by sex
Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.


Pediatric candidates who joined the waitlist in 2016. Candidates listed at more than one center are counted once per listing. DD, deceased donor; LD, living donor.

Figure LI 107. Three-year outcomes for newly listed pediatric candidates waiting for liver transplant, 2015-2017
Pediatric candidates who joined the waitlist in 2016. Candidates listed at more than one center are counted once per listing. DD, deceased donor; LD, living donor.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately.

Figure LI 108. Overall deceased donor liver transplant rates among pediatric waitlist candidates
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately.

Figure LI 109. Deceased donor liver transplant rates among pediatric waitlist candidates by age
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately.

Figure LI 110. Deceased donor liver transplant rates among pediatric waitlist candidates by race
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately. Medical urgency group is determined at the later of listing date and January 1 of the given year. Pediatric candidates aged 12 to 17 years can be assigned MELD or PELD scores.

Figure LI 111. Deceased donor liver transplant rates among pediatric waitlist candidates by allocation MELD/PELD
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately. Medical urgency group is determined at the later of listing date and January 1 of the given year. Pediatric candidates aged 12 to 17 years can be assigned MELD or PELD scores.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately. Medical urgency group is determined at the later of listing date and January 1 of the given year.

Figure LI 112. Deceased donor liver transplant rates among pediatric waitlist candidates by Status 1A or 1B
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately. Medical urgency group is determined at the later of listing date and January 1 of the given year.


Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately.

Figure LI 113. Deceased donor liver transplant rates among pediatric waitlist candidates by metropolitan vs. non-metropolitan residence
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LI 114. Overall pretransplant mortality rates among pediatric candidates waitlisted for liver
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LI 115. Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by age
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LI 116. Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by race
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.


Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.  Urban/rural determination is made using the RUCA (Rural-Urban Commuting Area) designation of the candidate

Figure LI 117. Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by metropolitan vs. non-metropolitan residence
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (Rural-Urban Commuting Area) designation of the candidate's permanent zip code.


All pediatric liver transplant recipients, including retransplant, and multi-organ recipients.

Figure LI 118. Overall pediatric liver transplants
All pediatric liver transplant recipients, including retransplant, and multi-organ recipients.


All pediatric liver transplant recipients, including retransplant, and multi-organ recipients.

Figure LI 119. Pediatric liver transplants by donor type
All pediatric liver transplant recipients, including retransplant, and multi-organ recipients.


All pediatric liver transplant recipients, including retransplant, and multi-organ recipients.

Figure LI 120. Pediatric liver transplants by recipient age
All pediatric liver transplant recipients, including retransplant, and multi-organ recipients.


Relationship of living donor to recipient is as indicated on the OPTN Living Donor Registration Form.

Figure LI 121. Pediatric liver transplants from living donors by relation
Relationship of living donor to recipient is as indicated on the OPTN Living Donor Registration Form.


All pediatric living liver transplant recipients, including retransplant, and multi-organ recipients.

Figure LI 122. Percent of pediatric liver transplants from living donors by recipient age
All pediatric living liver transplant recipients, including retransplant, and multi-organ recipients.


Adult centers transplanted only recipients aged 18 years or older. Functionally adult centers transplanted 80% adults or more, and the remainder were children aged 15-17 years. Mixed included adults and children of any age groups. Pediatric center transplanted recipients aged 0-17 years, and a small number of adults up to age 21 years.

Figure LI 123. Number of centers performing pediatric and adult liver transplants by center's age mix
Adult centers transplanted only recipients aged 18 years or older. Functionally adult centers transplanted 80% adults or more, and the remainder were children aged 15-17 years. Mixed included adults and children of any age groups. Pediatric center transplanted recipients aged 0-17 years, and a small number of adults up to age 21 years.


Age groups are cumulative.

Figure LI 124. Pediatric liver recipients at programs that perform 5 or fewer pediatric transplants annually
Age groups are cumulative.


Percent of transplants from a split liver.

Figure LI 125. Split or partial liver transplants in children
Percent of transplants from a split liver.


Exceptions among those allocated by MELD/PELD. Denominator excludes status 1A and 1B recipients.

Figure LI 126. Percent of pediatric and adult liver transplant recipients allocated by exception
Exceptions among those allocated by MELD/PELD. Denominator excludes status 1A and 1B recipients.


Exceptions among those allocated by MELD/PELD. Denominator excludes status 1A and 1B recipients.

Figure LI 127. Percent of pediatric liver transplant recipients using exceptions, 2018-2020, by DSA
Exceptions among those allocated by MELD/PELD. Denominator excludes status 1A and 1B recipients.


Immunosuppression at transplant reported to the OPTN.

Figure LI 128. Induction agent use in pediatric liver transplant recipients
Immunosuppression at transplant reported to the OPTN.


Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, all mycophenolate agents.

Figure LI 129. Immunosuppression regimen use in pediatric liver transplant recipients
Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, all mycophenolate agents.


Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2018.

Figure LI 130. Total HLA A, B, and DR mismatches among pediatric deceased donor liver-kidney transplant recipients, 2015-2019
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2018.


All pediatric recipients of deceased donor livers, including multi-organ transplants. Estimates are unadjusted, computed using Kaplan-Meier methods. Recipients are followed to the earliest of retransplant; death; or 6 months, 1, 3, 5, or 10 years posttransplant. All-cause graft failure (GF) is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.

Figure LI 131. Graft failure among pediatric deceased donor liver transplant recipients
All pediatric recipients of deceased donor livers, including multi-organ transplants. Estimates are unadjusted, computed using Kaplan-Meier methods. Recipients are followed to the earliest of retransplant; death; or 6 months, 1, 3, 5, or 10 years posttransplant. All-cause graft failure (GF) is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.


All pediatric recipients of living donor livers, including multi-organ transplants. Estimates are unadjusted, computed using Kaplan-Meier methods. Recipients are followed to the earliest of retransplant; death; or 6 months, 1, 3, 5, or 10 years posttransplant. All-cause graft failure (GF) is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.

Figure LI 132. Graft failure among pediatric living donor liver transplant recipients
All pediatric recipients of living donor livers, including multi-organ transplants. Estimates are unadjusted, computed using Kaplan-Meier methods. Recipients are followed to the earliest of retransplant; death; or 6 months, 1, 3, 5, or 10 years posttransplant. All-cause graft failure (GF) is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.


Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 133. Graft survival among pediatric deceased donor liver transplant recipients, 2013-2015, by age
Recipient survival estimated using unadjusted Kaplan-Meier methods.


Graft survival estimated using unadjusted Kaplan-Meier methods. Chol. disease, cholestatic disease.

Figure LI 134. Graft survival among pediatric deceased donor liver transplant recipients, 2013-2015, by diagnosis
Graft survival estimated using unadjusted Kaplan-Meier methods. Chol. disease, cholestatic disease.


Graft survival estimated using unadjusted Kaplan-Meier methods. Pediatric candidates aged 12 to 17 years can be assigned MELD or PELD scores.

Figure LI 135. Graft survival among pediatric deceased donor liver transplant recipients, 2013-2015, by lab MELD/PELD score
Graft survival estimated using unadjusted Kaplan-Meier methods. Pediatric candidates aged 12 to 17 years can be assigned MELD or PELD scores.


Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 136. Graft survival among pediatric liver transplant recipients, 2013-2015, by donor type
Recipient survival estimated using unadjusted Kaplan-Meier methods.


Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

Figure LI 137. Incidence of acute rejection by 1 year posttransplant among pediatric liver transplant recipients by age, 2018-2019
Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.


Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin

Figure LI 138. Incidence of PTLD among pediatric liver transplant recipients by recipient EBV status at transplant, 2008-2018
Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus.


All pediatric recipients of deceased donor livers, including multi-organ transplants.  Estimates are unadjusted, computed using unadjusted Kaplan-Meier methods.

Figure LI 139. Patient death among pediatric liver transplant recipients
All pediatric recipients of deceased donor livers, including multi-organ transplants. Estimates are unadjusted, computed using unadjusted Kaplan-Meier methods.


Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 140. Overall patient survival among pediatric deceased donor liver transplant recipients, 2013-2015
Recipient survival estimated using unadjusted Kaplan-Meier methods.


Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 141. Patient survival among pediatric deceased donor liver transplant recipients, 2013-2015, by recipient age
Recipient survival estimated using unadjusted Kaplan-Meier methods.


Recipient survival estimated using unadjusted Kaplan-Meier methods. Chol. disease, cholestatic disease.

Figure LI 142. Patient survival among pediatric deceased donor liver transplant recipients, 2013-2015, by diagnosis
Recipient survival estimated using unadjusted Kaplan-Meier methods. Chol. disease, cholestatic disease.


Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 143. Patient survival among pediatric liver transplant recipients, 2013-2015, by donor type
Recipient survival estimated using unadjusted Kaplan-Meier methods.


Table LI 1. Demographic characteristics of adults on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date. Distance is computed from candidate's home zip code to the transplant center.
Characteristic 2010, N 2010, Percent 2020, N 2020, Percent
Age: 18-34 years 686 4.3% 591 5.0%
Age: 35-49 years 2649 16.5% 1898 16.1%
Age: 50-64 years 10,400 64.8% 5867 49.9%
Age: ≥ 65 years 2308 14.4% 3409 29.0%
Sex: Female 6218 38.8% 4596 39.1%
Sex: Male 9825 61.2% 7169 60.9%
Race/ethnicity: White 11,249 70.1% 7969 67.7%
Race/ethnicity: Black 1130 7.0% 799 6.8%
Race/ethnicity: Hispanic 2714 16.9% 2217 18.8%
Race/ethnicity: Asian 791 4.9% 612 5.2%
Race/ethnicity: Other/unknown 159 1.0% 168 1.4%
Geography: Metropolitan 13,578 84.6% 10,069 85.6%
Geography: Non-metro 2465 15.4% 1696 14.4%
Distance: < 50 miles 9245 57.6% 7033 59.8%
Distance: 50-<100 miles 2708 16.9% 2110 17.9%
Distance: 100-<150 miles 1387 8.6% 1010 8.6%
Distance: 150-<250 miles 1279 8.0% 861 7.3%
Distance: ≥ 250 miles 1311 8.2% 718 6.1%
Distance: Unknown 113 0.7% 33 0.3%
All candidates 16,043 100.0% 11,765 100.0%



Table LI 2. Clinical characteristics of adults on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date. HCC, hepatocellular carcinoma; HCV, hepatitis C virus.
Characteristic 2010, N 2010, Percent 2020, N 2020, Percent
Diagnosis: Acute liver failure 388 2.4% 151 1.3%
Diagnosis: HCV 4952 30.9% 1411 12.0%
Diagnosis: Alcoholic liver disease 3560 22.2% 3782 32.1%
Diagnosis: Cholestatic disease 1516 9.4% 954 8.1%
Diagnosis: HCC 767 4.8% 1327 11.3%
Diagnosis: Other/unknown 4860 30.3% 4140 35.2%
Blood type: A 6088 37.9% 4607 39.2%
Blood type: B 1805 11.3% 1162 9.9%
Blood type: AB 375 2.3% 270 2.3%
Blood type: O 7775 48.5% 5726 48.7%
Medical urgency: Status 1A 2 0.0% 2 0.0%
Medical urgency: MELD ≥ 35 58 0.4% 47 0.4%
Medical urgency: MELD 30-34 136 0.8% 58 0.5%
Medical urgency: MELD 15-29 4571 28.5% 3971 33.8%
Medical urgency: MELD < 15 8300 51.7% 5087 43.2%
Medical urgency: Inactive 2976 18.6% 2600 22.1%
Exception status: None 14,539 90.6% 9577 81.4%
Exception status: HCC 1088 6.8% 1903 16.2%
Exception status: Other 416 2.6% 285 2.4%
All candidates 16,043 100.0% 11,765 100.0%



Table LI 3. Listing characteristics of adults on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date.
Characteristic 2010, N 2010, Percent 2020, N 2020, Percent
Transplant history: First 15,566 97.0% 11,486 97.6%
Transplant history: Retransplant 477 3.0% 279 2.4%
Wait time: < 1 year 6016 37.5% 5365 45.6%
Wait time: 1-< 2 years 2672 16.7% 2474 21.0%
Wait time: 2-< 3 years 1935 12.1% 1259 10.7%
Wait time: 3-< 4 years 1401 8.7% 786 6.7%
Wait time: 4-< 5 years 1008 6.3% 460 3.9%
Wait time: ≥ 5 years 3011 18.8% 1421 12.1%
Tx type: Liver alone 15,368 95.8% 10,790 91.7%
Tx type: Liver-kidney 594 3.7% 861 7.3%
Tx type: Liver-pancreas-intestine 33 0.2% 46 0.4%
Tx type: Liver-heart 23 0.1% 40 0.3%
Tx type: Other 25 0.2% 28 0.2%
All candidates 16,043 100.0% 11,765 100.0%



Table LI 4. Liver transplant waitlist activity among adults
Candidates listed at more than one center are counted once per listing. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.
Waiting list state 2018 2019 2020
Patients at start of year 13,590 13,087 12,527
Patients added during year 12,418 12,766 12,409
Patients removed during year 12,897 13,307 13,164
Patients at end of year 13,111 12,546 11,772



Table LI 5. Removal reason among adult liver transplant candidates
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason 2018 2019 2020
Deceased donor transplant 7295 7850 7914
Living donor transplant 338 442 425
Transplant outside US 2 1 1
Patient died 1288 1303 1195
Patient refused transplant 138 114 117
Improved, transplant not needed 974 890 902
Too sick for transplant 1252 1112 1173
Other 1610 1595 1437



Table LI 6. Complications among living liver donors, 2016-2020
Complications reported on the OPTN Living Donor Registration Form. Clavien Grade 1, bilious Jackson Pratt drainage more than 10 days; Clavien Grade 2, interventional procedure (endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, percutaneous drainage, etc.); Clavien Grade 3, surgical intervention. Clavien grades refer to biliary complications. Domino liver donors excluded.
Level N Pct
Biliary complication: Yes 54 2.6%
Biliary complication: No 2032 97.3%
Biliary complication: Unknown 2 0.1%
Clavien Grade: 1 18 0.9%
Clavien Grade: 2 31 1.5%
Clavien Grade: 3 9 0.4%
Vascular complication, requiring intervention: Yes 17 0.8%
Vascular complication, requiring intervention: No 2069 99.1%
Vascular complication, requiring intervention: Unknown 2 0.1%
Other complication, requiring intervention: Yes 111 5.3%
Other complication, requiring intervention: No 1975 94.6%
Other complication, requiring intervention: Unknown 2 0.1%
Re-operation: Yes 43 2.1%
Re-operation: No 2042 97.8%
Re-operation: Unknown 3 0.1%



Table LI 7. Living liver donor deaths in the first year after donoation, 2016-2020, by number of days after donation
Living liver donors. Number of deaths reported to OPTN or Social Security Administration. Donation-related deaths are included in the Medical category.
Cause 0-30 days 31-90 days 91-365 days
Suicide 0 0 0
Accident/homicide 0 0 0
Medical 1 0 0
Cancer 0 0 0
Unknown 0 0 0
TOTAL 1 0 0



Table LI 8. Demographic characteristics of adult liver transplant recipients, 2010 and 2020
Liver transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.
Characteristic 2010, N 2010, Percent 2020, N 2020, Percent
Age: 18-34 years 352 6.1% 606 7.2%
Age: 35-49 years 1020 17.8% 1751 20.8%
Age: 50-64 years 3643 63.6% 4054 48.2%
Age: ≥ 65 years 716 12.5% 1993 23.7%
Sex: Female 1962 34.2% 3090 36.8%
Sex: Male 3769 65.8% 5314 63.2%
Race/ethnicity: White 4054 70.7% 5887 70.0%
Race/ethnicity: Black 587 10.2% 614 7.3%
Race/ethnicity: Hispanic 746 13.0% 1413 16.8%
Race/ethnicity: Asian 261 4.6% 364 4.3%
Race/ethnicity: Other/unknown 83 1.4% 126 1.5%
BMI: < 18.5 kg/m2 132 2.3% 142 1.7%
BMI: 18.5-< 25 kg/m2 1634 28.5% 2242 26.7%
BMI: 25-< 28 kg/m2 1274 22.2% 1646 19.6%
BMI: 28-< 30 kg/m2 692 12.1% 1037 12.3%
BMI: 30-< 35 kg/m2 1253 21.9% 1876 22.3%
BMI: ≥ 35 kg/m2 744 13.0% 1429 17.0%
BMI: Unknown 2 0.0% 32 0.4%
Insurance: Private 3298 57.5% 4266 50.8%
Insurance: Medicare 1379 24.1% 2427 28.9%
Insurance: Medicaid 814 14.2% 1373 16.3%
Insurance: Unknown 240 4.2% 338 4.0%
Geography: Metropolitan 4784 83.5% 6979 83.0%
Geography: Non-metro 947 16.5% 1425 17.0%
Distance: < 50 miles 3223 56.2% 4794 57.0%
Distance: 50-<100 miles 946 16.5% 1543 18.4%
Distance: 100-<150 miles 546 9.5% 785 9.3%
Distance: 150-<250 miles 477 8.3% 633 7.5%
Distance: ≥ 250 miles 476 8.3% 577 6.9%
Distance: Unknown 63 1.1% 72 0.9%
All recipients 5731 100.0% 8404 100.0%



Table LI 9. Clinical characteristics of adult liver transplant recipients, 2010 and 2020
Liver transplant recipients, including retransplants. HCC, hepatocellular carcinoma; HCV, hepatitis C virus.
Characteristic 2010, N 2010, Percent 2020, N 2020, Percent
Diagnosis: Acute liver failure 246 4.3% 212 2.5%
Diagnosis: HCV 1525 26.6% 566 6.7%
Diagnosis: Alcoholic liver disease 964 16.8% 2957 35.2%
Diagnosis: Cholestatic disease 493 8.6% 700 8.3%
Diagnosis: HCC 988 17.2% 1063 12.6%
Diagnosis: Other/unknown 1515 26.4% 2906 34.6%
Blood type: A 2073 36.2% 3099 36.9%
Blood type: B 799 13.9% 1113 13.2%
Blood type: AB 282 4.9% 418 5.0%
Blood type: O 2577 45.0% 3774 44.9%
Medical condition: Hospitalized in ICU 767 13.4% 1206 14.4%
Medical condition: Hospitalized, not ICU 1147 20.0% 1920 22.8%
Medical condition: Not hospitalized 3817 66.6% 5243 62.4%
Medical condition: Hospitalization unknown 0 0.0% 35 0.4%
Medical urgency: Status 1A 246 4.3% 202 2.4%
Medical urgency: MELD ≥ 35 1009 17.6% 1755 20.9%
Medical urgency: MELD 30-34 643 11.2% 1534 18.3%
Medical urgency: MELD 15-29 3649 63.7% 4369 52.0%
Medical urgency: MELD < 15 184 3.2% 538 6.4%
Medical urgency: Unknown 0 0.0% 6 0.1%
HCC exception 1364 23.8% 1390 16.5%
Other MELD exception 621 10.8% 452 5.4%
Diabetes 1442 25.2% 2429 28.9%
All recipients 5731 100.0% 8404 100.0%



Table LI 10. Transplant characteristics of adult liver transplant recipients, 2010 and 2020
Liver transplant recipients, including retransplants. DBD, donation after brain death; DCD, donation after circulatory death.
Characteristic 2010, N 2010, Percent 2020, N 2020, Percent
Wait time: < 31 days 1914 33.4% 3677 43.8%
Wait time: 31-60 days 635 11.1% 704 8.4%
Wait time: 61-90 days 455 7.9% 482 5.7%
Wait time: 3-< 6 months 849 14.8% 903 10.7%
Wait time: 6-< 12 months 847 14.8% 1426 17.0%
Wait time: 1-< 2 years 562 9.8% 765 9.1%
Wait time: 2-< 3 years 175 3.1% 214 2.5%
Wait time: ≥ 3 years 294 5.1% 233 2.8%
Donor type: Deceased 5516 96.2% 7979 94.9%
Donor type: Living 215 3.8% 425 5.1%
Procedure: Whole liver 5454 95.2% 7914 94.2%
Procedure: Partial liver 205 3.6% 420 5.0%
Procedure: Split liver 72 1.3% 70 0.8%
DCD status: DBD 5468 95.4% 7574 90.1%
DCD status: DCD 263 4.6% 830 9.9%
Transplant history: First 5368 93.7% 8045 95.7%
Transplant history: Retransplant 363 6.3% 359 4.3%
Tx type: Liver only 5304 92.5% 7556 89.9%
Tx type: Liver-kidney 382 6.7% 762 9.1%
Tx type: Liver-intestine-pancreas 24 0.4% 18 0.2%
Tx type: Other 21 0.4% 68 0.8%
All recipients 5731 100.0% 8404 100.0%



Table LI 11. Adult deceased donor liver donor-recipient serology matching, 2018-2020
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. Donor HCV NAT data are shown by recipient HCV antibody status. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBsAg, hepatitis B surace antigen; HCV, hepatitis C virus; HIV, human immunodeficiency virus; NAT, nucleic acid test.
Donor Recipient CMV EBV HBsAg HCV antibody HCV NAT
D- R- 14.2% 0.6% 95.0% 73.7% 76.1%
D- R+ 22.0% 5.9% 3.4% 14.9% 16.0%
D- R unk 0.3% 1.3% 1.4% 1.7% 1.7%
D+ R- 23.1% 6.0% 0.1% 6.2% 3.8%
D+ R+ 39.3% 74.8% 0.0% 3.3% 2.3%
D+ R unk 0.6% 11.2% 0.0% 0.2% 0.1%
D unk R- 0.2% 0.0% 0.0% 0.0% 0.0%
D unk R+ 0.3% 0.1% 0.0% 0.0% 0.0%
D unk R unk 0.0% 0.1% 0.0% 0.0% 0.0%



Table LI 12. Adult living donor liver donor-recipient serology matching, 2018-2020
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. Donor HCV NAT data are shown by recipient HCV antibody status. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; HIV, human immunodeficiency virus; NAT, nucleic acid test.
Donor Recipient CMV EBV HBsAg HCV antibody HCV NAT
D- R- 30.2% 1.2% 95.0% 85.7% 83.6%
D- R+ 24.7% 10.8% 2.2% 10.7% 10.9%
D- R unk 0.2% 1.5% 1.0% 1.2% 1.2%
D+ R- 14.5% 5.8% 0.2% 0.4% 0.0%
D+ R+ 27.8% 70.1% 0.0% 0.3% 0.0%
D+ R unk 0.3% 6.9% 0.0% 0.1% 0.0%
D unk R- 1.1% 0.2% 1.7% 1.3% 3.8%
D unk R+ 1.2% 1.7% 0.0% 0.2% 0.2%
D unk R unk 0.0% 1.7% 0.0% 0.1% 0.2%



Table LI 13. Demographic characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Candidates aged younger than 18 years waiting for transplant on December 31 of given year, regardless of first listing date. Age calculated at snapshot. Candidates listed as children who turned 18 before the cohort date are excluded. Distance is computed from candidate's home zip code to the transplant center.
Characteristic 2010, N 2010, Percent 2020, N 2020, Percent
Age: < 1 year 47 8.8% 42 12.4%
Age: 1-5 years 186 35.0% 118 34.7%
Age: 6-10 years 132 24.8% 83 24.4%
Age: 11-17 years 167 31.4% 97 28.5%
Sex: Female 273 51.3% 175 51.5%
Sex: Male 259 48.7% 165 48.5%
Race/ethnicity: White 269 50.6% 141 41.5%
Race/ethnicity: Black 78 14.7% 60 17.6%
Race/ethnicity: Hispanic 144 27.1% 104 30.6%
Race/ethnicity: Asian 30 5.6% 23 6.8%
Race/ethnicity: Other/unknown 11 2.1% 12 3.5%
Geography: Metropolitan 457 85.9% 294 86.5%
Geography: Non-metro 75 14.1% 46 13.5%
Distance: < 50 miles 265 49.8% 165 48.5%
Distance: 50-<100 miles 71 13.3% 62 18.2%
Distance: 100-<150 miles 48 9.0% 35 10.3%
Distance: 150-<250 miles 61 11.5% 30 8.8%
Distance: ≥ 250 miles 78 14.7% 42 12.4%
Distance: Unknown 9 1.7% 6 1.8%
All candidates 532 100.0% 340 100.0%



Table LI 14. Clinical characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Candidates aged younger than 18 years waiting for transplant on December 31 of the given year, regardless of first listing date. Candidates listed as children who turned 18 before the cohort date are excluded. Pediatric candidates aged 12 to 17 years can be assigned MELD or PELD scores.
Characteristic 2010, N 2010, Percent 2020, N 2020, Percent
Diagnosis: Acute liver failure 44 8.3% 20 5.9%
Diagnosis: Cholestatic biliary atresia 169 31.8% 129 37.9%
Diagnosis: Other cholestatic 52 9.8% 44 12.9%
Diagnosis: Hepatoblastoma 7 1.3% 3 0.9%
Diagnosis: Metabolic 61 11.5% 34 10.0%
Diagnosis: Other/unknown 199 37.4% 110 32.4%
Blood type: A 160 30.1% 96 28.2%
Blood type: B 71 13.3% 40 11.8%
Blood type: AB 9 1.7% 7 2.1%
Blood type: O 292 54.9% 197 57.9%
Medical urgency: Status 1A 1 0.2% 0 0.0%
Medical urgency: Status 1B 4 0.8% 14 4.1%
Medical urgency: MELD/PELD ≥ 30 71 13.3% 55 16.2%
Medical urgency: MELD/PELD 15-29 93 17.5% 67 19.7%
Medical urgency: MELD/PELD < 15 157 29.5% 80 23.5%
Medical urgency: Inactive 206 38.7% 124 36.5%
Exception status: None 434 81.6% 258 75.9%
Exception status: Granted 98 18.4% 82 24.1%
All candidates 532 100.0% 340 100.0%



Table LI 15. Listing characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2010 and December 31, 2020
Candidates aged younger than 18 years waiting for transplant on December 31 of the given year, regardless of first listing date. Candidates listed as children who turned 18 before the cohort date are excluded.
Characteristic 2010, N 2010, Percent 2020, N 2020, Percent
Transplant history: First 476 89.5% 311 91.5%
Transplant history: Retransplant 56 10.5% 29 8.5%
Wait time: < 1 year 259 48.7% 185 54.4%
Wait time: 1-< 2 years 90 16.9% 52 15.3%
Wait time: 2-< 3 years 28 5.3% 31 9.1%
Wait time: 3-< 4 years 30 5.6% 21 6.2%
Wait time: 4-< 5 years 24 4.5% 17 5.0%
Wait time: ≥ 5 years 101 19.0% 34 10.0%
Tx type: Liver alone 460 86.5% 273 80.3%
Tx type: Liver-kidney 8 1.5% 13 3.8%
Tx type: Liver-pancreas-intestine 44 8.3% 47 13.8%
Tx type: Liver-heart 1 0.2% 5 1.5%
Tx type: Other 19 3.6% 2 0.6%
All candidates 532 100.0% 340 100.0%



Table LI 16. Liver transplant waitlist activity among pediatric candidates
Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.
Waiting list state 2018 2019 2020
Patients at start of year 546 517 461
Patients added during year 734 686 617
Patients removed during year 763 741 676
Patients at end of year 517 462 402



Table LI 17. Removal reason among pediatric liver transplant candidates
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason 2018 2019 2020
Deceased donor transplant 511 483 455
Living donor transplant 62 82 66
Transplant outside US 0 0 0
Patient died 33 29 17
Patient refused transplant 1 1 3
Improved, transplant not needed 91 87 74
Too sick for transplant 20 15 16
Other 45 44 45



Table LI 18. Demographic characteristics of pediatric liver transplant recipients, 2008-2010 and 2018-2020
Pediatric liver transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.
Characteristic 2008-10, N 2008-10, Percent 2018-20, N 2018-20, Percent
Age: < 1 year 515 29.5% 448 27.7%
Age: 1-5 years 673 38.6% 585 36.2%
Age: 6-10 years 238 13.6% 229 14.2%
Age: 11-17 years 319 18.3% 354 21.9%
Sex: Female 869 49.8% 789 48.8%
Sex: Male 876 50.2% 827 51.2%
Race/ethnicity: White 894 51.2% 795 49.2%
Race/ethnicity: Black 302 17.3% 270 16.7%
Race/ethnicity: Hispanic 399 22.9% 381 23.6%
Race/ethnicity: Asian 108 6.2% 125 7.7%
Race/ethnicity: Other/unknown 42 2.4% 45 2.8%
Insurance: Private 732 41.9% 595 36.8%
Insurance: Medicare 13 0.7% 17 1.1%
Insurance: Medicaid 798 45.7% 792 49.0%
Insurance: Other government 139 8.0% 133 8.2%
Insurance: Unknown 63 3.6% 79 4.9%
Geography: Metropolitan 1424 81.6% 1360 84.2%
Geography: Non-metro 321 18.4% 256 15.8%
Distance: < 50 miles 807 46.2% 807 49.9%
Distance: 50-<100 miles 264 15.1% 242 15.0%
Distance: 100-<150 miles 172 9.9% 164 10.1%
Distance: 150-<250 miles 191 10.9% 159 9.8%
Distance: ≥ 250 miles 270 15.5% 206 12.7%
Distance: Unknown 41 2.3% 38 2.4%
All recipients 1745 100.0% 1616 100.0%



Table LI 19. Clinical characteristics of pediatric liver transplant recipients, 2008-2010 and 2018-2020
Pediatric liver transplant recipients, including retransplants. Pediatric candidates aged 12 to 17 years can be assigned MELD or PELD scores.
Characteristic 2008-10, N 2008-10, Percent 2018-20, N 2018-20, Percent
Diagnosis: Acute liver failure 190 10.9% 125 7.7%
Diagnosis: Cholestatic biliary atresia 572 32.8% 537 33.2%
Diagnosis: Other cholestatic 225 12.9% 212 13.1%
Diagnosis: Hepatoblastoma 105 6.0% 114 7.1%
Diagnosis: Metabolic 204 11.7% 279 17.3%
Diagnosis: Other/unknown 449 25.7% 349 21.6%
Blood type: A 598 34.3% 551 34.1%
Blood type: B 243 13.9% 198 12.3%
Blood type: AB 54 3.1% 48 3.0%
Blood type: O 850 48.7% 819 50.7%
Medical condition: Hospitalized in ICU 445 25.5% 281 17.4%
Medical condition: Hospitalized, not ICU 309 17.7% 278 17.2%
Medical condition: Not hospitalized 991 56.8% 1057 65.4%
Medical urgency: Status 1A 264 15.1% 173 10.7%
Medical urgency: Status 1B 221 12.7% 359 22.2%
Medical urgency: MELD/PELD ≥ 30 481 27.6% 707 43.8%
Medical urgency: MELD/PELD 15-29 526 30.1% 209 12.9%
Medical urgency: MELD/PELD < 15 249 14.3% 163 10.1%
Medical urgency: Unknown 4 0.2% 5 0.3%
Any MELD/PELD exception 521 29.9% 757 46.8%
All recipients 1745 100.0% 1616 100.0%



Table LI 20. Transplant characteristics of pediatric liver transplant recipients, 2008-2010 and 2018-2020
Pediatric liver transplant recipients, including retransplants. DBD, donation after brain death; DCD, donation after circulatory death.
Characteristic 2008-10, N 2008-10, Percent 2018-20, N 2018-20, Percent
Wait time: < 31 days 720 41.3% 502 31.1%
Wait time: 31-60 days 286 16.4% 257 15.9%
Wait time: 61-90 days 179 10.3% 189 11.7%
Wait time: 3-< 6 months 265 15.2% 313 19.4%
Wait time: 6-< 12 months 157 9.0% 182 11.3%
Wait time: 1-< 2 years 89 5.1% 102 6.3%
Wait time: 2-< 3 years 23 1.3% 34 2.1%
Wait time: ≥ 3 years 22 1.3% 37 2.3%
Wait time: Unknown 4 0.2% 0 0.0%
ABO: Compatible/identical 1682 96.4% 1526 94.4%
ABO: Incompatible 63 3.6% 90 5.6%
Donor type: Deceased 1556 89.2% 1409 87.2%
Donor type: Living 189 10.8% 207 12.8%
Procedure: Whole liver 1114 63.8% 989 61.2%
Procedure: Partial liver 342 19.6% 320 19.8%
Procedure: Split liver 289 16.6% 307 19.0%
DCD status: DBD 1732 99.3% 1611 99.7%
DCD status: DCD 13 0.7% 5 0.3%
Transplant history: First 1580 90.5% 1511 93.5%
Transplant history: Retransplant 165 9.5% 105 6.5%
Tx type: Liver only 1522 87.2% 1483 91.8%
Tx type: Liver-kidney 37 2.1% 52 3.2%
Tx type: Liver-intestine-pancreas 147 8.4% 64 4.0%
Tx type: Liver-intestine 18 1.0% 3 0.2%
Tx type: Other 21 1.2% 14 0.9%
All recipients 1745 100.0% 1616 100.0%



Table LI 21. Pediatric liver donor-recipient serology matching, 2018-2020
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. CMV, cytomegalovirus; EBV, Epstein-Barr virus.
Donor Recipient CMV EBV
D- R- 32.6% 18.9%
D- R+ 19.2% 12.5%
D- R unk 0.7% 0.8%
D+ R- 30.2% 36.9%
D+ R+ 16.5% 28.6%
D+ R unk 0.5% 2.0%
D unk R- 0.1% 0.1%
D unk R+ 0.1% 0.2%
D unk R unk 0.0% 0.0%



Table LI 22. Pediatric liver donor-recipient serology matching for living donors, 2018-2020
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. CMV, cytomegalovirus; EBV, Epstein-Barr virus.
Donor Recipient CMV EBV
D- R- 34.8% 7.7%
D- R+ 10.6% 5.3%
D- R unk 0.5% 0.0%
D+ R- 26.6% 59.4%
D+ R+ 23.2% 24.6%
D+ R unk 0.5% 1.0%
D unk R- 3.9% 0.5%
D unk R+ 0.0% 1.4%
D unk R unk 0.0% 0.0%