OPTN/SRTR 2021 Annual Data Report: Liver

Allison J. Kwong¹, Noelle H. Ebel², W. Ray Kim^1,3, John R. Lake^3,4, Jodi M. Smith^3,5, David P. Schladt³, Erin M. Schnellinger⁶, Dzhuliyana Handarova⁶, Samantha Weiss⁶, Matthew Cafarella⁶, Jon J. Snyder^3,7,8, Ajay K. Israni^3,7,8, Bertram L. Kasiske^3,8

¹Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA

²Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA

³Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN

⁴Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN

⁵Department of Pediatrics, University of Washington, Seattle, WA

⁶Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA

⁷Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN

⁸Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN

Abstract

In 2021, liver transplant volume continued to grow, with a record 9,234 transplants performed in the United States, 8,665 (93.8%) from deceased donors and 569 (6.2%) from living donors. There were 8,733 (94.6%) adult and 501 (5.4%) pediatric liver transplant recipients. An increase in the number of deceased donor livers corresponded to an increase in the overall transplant rate and shorter waiting times, although still 10.0% of livers that were recovered were not transplanted. Alcohol-associated liver disease was the leading indication for both waitlist registration and liver transplant in adults, outpacing nonalcoholic steatohepatitis, while biliary atresia remained the leading indication for children. Related to allocation policy changes implemented in 2019, the proportion of liver transplants performed for hepatocellular carcinoma has decreased. Among adult candidates listed for liver transplant in 2020, 37.7% received a deceased donor liver transplant within 3 months, 43.8% within 6 months, and 53.3% within 1 year. Pretransplant mortality improved for children following implementation of acuity circle–based distribution. Short-term graft and patient survival outcomes up to 1 year worsened for adult deceased and living donor liver transplant recipients, which is a reversal of previous trends and coincided with the onset of the COVID-19 pandemic in early 2020. Longer-term outcomes among adult deceased donor liver transplant recipients were unaffected, with overall posttransplant mortality rates of 13.3% at 3 years, 18.6% at 5 years, and 35.9% at 10 years. Pretransplant mortality improved for children following implementation of acuity circle–based distribution and prioritization of pediatric donors to pediatric recipients in 2020. Pediatric living donor recipients had superior graft and patient survival outcomes compared with deceased donor recipients at all time points.

Keywords: Liver transplant, allocation, distribution, waiting list

1 ADULT LIVER TRANSPLANTATION IN THE UNITED STATES

1.1 Waiting List

There were 11,771 adult candidates on the liver waiting list at the start of 2021, and 13,165 additional candidates were added during the calendar year, representing more new waitlist registrations than in any previous year (Figure LI 1, Table LI 4). Over the course of the year, 13,598 candidates were removed, leaving 11,338 candidates remaining on the liver transplant list on December 31, 2021.

Most adult candidates (48.0%) were 50-64 years of age, still representing the majority but a decrease from 63.9% in 2011. Those aged 65 years or older made up 27.4% of candidates, stable from the year prior but a substantial increase compared with 15.7% in 2011 (Figure LI 3). The sex and racial composition of the waiting list has remained relatively unchanged: 61.3% male, 38.7% female, 68.9% White, 6.8% Black, 18.0% Hispanic, and 4.7% Asian (Figures LI 4 and 5).

Alcohol-associated liver disease was the leading diagnosis among adult liver transplant candidates in 2021, representing 36.3% of waitlist registrations (Figure LI 6). This was followed by nonalcoholic steatohepatitis (19.3%) and other/unknown diagnoses (15.7%). The proportion of candidates with alcohol-associated liver disease and to a lesser extent nonalcoholic steatohepatitis has increased year-over-year, while the prevalence of hepatitis C virus (HCV) continued to decline, representing only 8.3% of diagnoses compared with 29.7% in 2011. The proportion of candidates with diagnoses of acute liver failure and cholestatic liver disease also declined in the past decade, representing only 1.9% and 7.8% of diagnoses, respectively, in 2021. Candidates with a primary diagnosis of hepatocellular carcinoma (HCC) made up 10.7% of new waitlist registrations.

The severity of liver disease, based on the last laboratory model for end-stage liver disease (MELD) score during the calendar year, continued to increase, with a greater proportion being listed with MELD score of 25-34 (15.7%), 35-39 (4.9%), and 40 or greater (4.9%) in 2021 compared with previous years (Figure LI 7). Obesity, defined as a body mass index (BMI) of 30 kg/m² or greater, was observed in 41.1% of adult candidates; 17.3% had BMI of 35 kg/m² or greater (Figure LI 8). Over the past decade, the proportion of candidates with a prior history of liver transplant declined from 4.0% to 3.1%, despite more transplants being performed overall (Figure LI 10). The distribution of blood types largely mirrored that in the general population: 47.7% O, 38.0% A, 11.3% B, and 3.0% AB (Figure LI 9).

1.2 Waitlist Outcomes

The overall deceased donor transplant rate among adult waitlist candidates continued to rise steadily, with an overall rate of 71.0 transplants per 100 patient-years (Figure LI 11). This increase occurred across all age groups, sexes, major racial and ethnic groups, blood types, and places of residence (metropolitan vs non-metropolitan) (Figures LI 12, 13, 14, 16, and 17). Still, men had higher transplant rates compared with women (73.8 vs 66.5 transplants per 100 patient-years). Candidates living in non-metropolitan areas, based on the rural-urban commuting area (RUCA) designation of their permanent zip code, had a higher transplant rate than those living in metropolitan areas. Candidates with blood type AB had the highest transplant rate (157.7 transplants per 100 patient-years), followed by type B (94.3 transplants per 100 patient-years), and then O and A (66.5 and 65.6 transplants per 100 patient-years, respectively) (Figure LI 14). Whereas candidates with HCC exception points historically had a much higher transplant rate than those without HCC, transplant rates for these two groups were essentially equal in 2021 (Figure LI 15). This observation occurred in the context of a policy change implemented in 2019, which set waitlist priority for HCC exception cases by the local median MELD at transplant minus 3 points.

Of the adults who were listed for liver transplant during 2016-2018, for whom at least 3 years of follow-up data were available, only 7.9% remained on the waiting list after 3 years (Figure LI 18). By the end of 3 years, 59.3% received a liver transplant (including 2.6% from a living donor), 9.3% died, and 23.5% were removed from the list for other reasons. Among candidates who were listed for liver transplant in 2020, 37.7% received a deceased donor liver transplant within 3 months, 43.8% within 6 months, and 53.3% within 1 year—all increases compared with previous years (Figure LI 19). By comparison, only 39.8% of candidates listed in 2011 received a deceased donor liver transplant within 1 year, 49.6% within 5 years, and 50.6% within 10 years.

In 2021, the pretransplant mortality rate was 13.1 deaths per 100 patient-years, compared with 15.5 deaths per 100 patient-years in 2011 (Figure LI 20). The pretransplant mortality rate was higher among women compared with men (14.1 vs 12.5 deaths per 100 patient-years), as well as older (65 years or older) compared with younger candidates, those with acute liver failure or nonalcoholic steatohepatitis compared with other diagnoses, and those living in non-metropolitan versus metropolitan areas (Figures LI 21, 23, 24, and 25). The pretransplant mortality rate has decreased over the past decade for candidates in all MELD groups (based on the first laboratory MELD score during the year) (Figure LI 26). The pretransplant mortality rate among patients waitlisted with an HCC exception remained lower than that observed in patients without HCC exceptions (10.9 vs 13.4 deaths per 100 patient-years) (Figure LI 27). Overall pretransplant mortality rates by donation service area (DSA) remain widely varied, ranging from 7.0 to 28.6 deaths per 100 patient-years (Figure LI 28).

Liver transplant was the most common reason for waitlist removal among adults, including 8,212 from a deceased donor and 492 from a living donor. The next most common reasons were death (1,134), being too sick for transplant (1,177), or condition improved with transplant no longer being needed (1,051) (Table LI 5). Deaths within 6 months after removal from the waiting list for reasons other than transplant or death decreased from 31.5% in 2011 to 15.1% in 2021; this outcome was highest among patients aged 65 years or older compared with other age groups (Figures LI 29 and 31).

1.3 Donation

The number of deceased liver donors continued to increase, reaching an all-time high of 9,540 in 2021, driven by growth in donors aged 30-39, 40-54, and 55 years or older (Figures LI 32 and 33). There were 683 pediatric donors younger than 18 years. This number has remained relatively stable in the past several years and represented 7.2% of deceased liver donors in 2021 (Figure LI 35). The sex and racial composition of donors has remained relatively unchanged: 62.3% male, 37.7% female, 62.7% White, 17.3% Black, 15.8% Hispanic, and 3.1% Asian (Figures LI 36 and 37). The number of livers with positive hepatitis C antibody has not increased as in previous years, but these livers do continue to make up a substantial proportion (9.1%) of deceased donor livers recovered in 2021 (Figures LI 34 and 38). Anoxia remains the most common cause of death among deceased liver donors (45.8%), followed by head trauma (26.6%) and cerebrovascular accident/stroke (25.7%) (Figure LI 47).

Overall, 10.0% of livers were recovered but not transplanted, an increase in the past 4 years, compared with 8.6% in 2018 (Figure LI 39). The trend may be explained at least in part by the increase in donation after circulatory death (DCD) livers (Table LI 8), which remained much less likely to be transplanted than donation after brain death (DBD) livers (29.4% vs 6.9%) (Figure LI 46). Livers from older donors (40 years or older) were also less likely to be transplanted (Figure LI 40). Livers with positive hepatitis C antibody or those at increased risk of disease transmission were not more likely to be unused (Figures LI 44 and 45).

Living donors were more likely to be women (56.3%) and White (77.8%) (Figures LI 50 and 51). Most donors were related to or directed to the recipient (Figure LI 48). In most cases, the right lobe of the liver was used (78.5%), an increasing trend over the past decade (Figure LI 52).

1.4 Transplants

In 2021, a record 9,234 liver transplants (adult and pediatric) were performed in the United States, of which 8,665 (93.8%) were from deceased donors and 569 (6.2%) were from living donors (Figures LI 54 and 55). The recipients were 61.7% male, 69.5% White, 16.7% Hispanic, 7.6% Black, and 4.4% Asian (Figures LI 57 and 58). The largest age group was adults aged 50-64 years, with a growing proportion of patients aged 35-49 years and no increase in the group aged 65 years or older in the past year (Figure LI 56).

Alcohol-associated liver disease was again the most common indication for liver transplant overall (ie, for adult and pediatric combined), making up 37.5% of transplants, followed by nonalcoholic steatohepatitis at 18.6% (Figure LI 59). Some proportion of recipients with other/unknown category, the third most common diagnosis (15.2%), may have also had liver disease due to nonalcoholic steatohepatitis. Liver transplants with a primary diagnosis of HCC declined to 10.9%, from 17.8% in 2011 and 16.1% in 2018. The prevalence of HCV also continued to decrease, representing only 4.7% of liver transplant recipients, compared with 22.6% in 2011.

Among the 8,733 adult recipients, 94.4% received livers from deceased donors and 5.6% from living donors (Table LI 8). The recipients were 62.4% male, 70.6% White, 16.5% Hispanic, 6.9% Black, and 4.2% Asian (Table LI 6). For BMI, 21.0% had BMI 30-<35 kg/m², and 15.3% had 35 kg/m² or greater. Most liver transplants were covered by private insurance (51.8%), followed by Medicare (26.7%) and Medicaid (17.1%). In terms of place of residence, 83.5% of recipients lived in metropolitan areas, compared with 14.8% in non-metropolitan areas; 56.8% lived less than 50 miles from the transplant center, 17.8% within 50-<100 miles, 9.7% within 100-<150 miles, 7.5% within 150-<250 miles, and 7.1% 250 miles or farther.

Alcohol-associated liver disease was the diagnosis for 39.6% of adult liver transplants, compared with 17.5% in 2011 (Table LI 7). This was followed by nonalcoholic steatohepatitis (19.6%), other/unknown (13.8%) and HCC (11.5%). Cholestatic liver disease (8.0%), HCV (5.0%), and acute liver failure (2.5%) were less frequent. The percentage of transplanted recipients with HCC exception points decreased to 15.8% from 25.4% in 2011. The most common recipient blood type was O (45.5%), followed by A (36.4%), B (13.4%), and AB (4.7%).

Most liver transplant recipients waited fewer than 90 days (62.1%), with only 13.5% waiting longer than 1 year (Table LI 8). Overall, waiting times were shorter compared with 2011. The proportion of adults who received DCD livers increased from 4.6% in 2011 to 10.5% in 2021, while the proportion of those who received split livers decreased from 1.1% to 0.8%. The proportion of recipients with a history of previous transplant decreased from 5.7% in 2011 to 3.6% in 2021.

Induction therapy was used in 31.1% of adult liver transplants in 2021, and 71.8% of adult liver transplant recipients received steroid-containing immunosuppressive regimens (Figures LI 61 and 62).

There were 780 simultaneous liver-kidney transplants in 2021 (adult and pediatric), representing 8.4% of liver transplant recipients during the calendar year (Figure LI 60). This proportion has been stable over the past several years and decreased from a peak of 9.4% in 2016, just prior to the introduction of standardized medical eligibility criteria for simultaneous liver-kidney transplant in 2017.

1.5 Outcomes

Among adult liver transplants performed in 2020, the most recent year for which at least 1 full year of follow-up was available, graft failure occurred in 7.0% of deceased donor liver transplant recipients at 6 months and 9.2% at 1 year, an increase compared with the previous year and reversal of a previous trend of improving short-term outcomes (Figure LI 63). This observation coincided with the onset of the COVID-19 pandemic in early 2020 among other trends. Longer-term graft outcomes for recipients of deceased donor liver transplant in 2018, 2016, and 2011 were similar to previous years, with a graft failure frequency of 15.0% at 3 years for transplants in 2018, 20.7% at 5 years for transplants in 2016, and 38.5% at 10 years for transplants in 2011.

Overall survival for adult liver transplant recipients followed a similar pattern to graft failure (ie, a detectable increase in short-term mortality but similar longer-term survival), with 5.7% mortality at 6 months, 7.8% at 1 year, 13.3% at 3 years, 18.6% at 5 years, and 35.9% at 10 years (Figure LI 65).

Outcomes were similar, if not better, for adult living donor liver transplant recipients, with graft failure occurring in 6.1% at 6 months, 8.7% at 1 year, 14.2% at 3 years, 19.4% at 5 years, and 42.0% at 10 years (Figure LI 64). Graft outcomes, however, were inferior compared with previous years.

Five-year graft survival rates among deceased donor liver transplant recipients who underwent transplant during 2014-2016 exceeded 75% across all categories and surpassed 80% among those aged 35-49 years (81.6%), those with cholestatic liver disease (80.9%), and those with a MELD score of 15-24 at transplant (80.8%) (Figures LI 66, 67, and 68). The 5-year graft survival rate among recipients of DCD livers was 75.9%, compared with 79.2% for recipients of DBD livers (Figure LI 69). Five-year graft outcomes were equivalent between those with and without HCC exception points (Figure LI 70). Patient survival after deceased donor liver transplant largely mirrored that of graft survival, exceeding 80% except for those aged 65 years or older (77.4%) and those with acute liver failure (79.2%), HCC (79.4%), nonalcoholic steatohepatitis (79.7%), and a MELD score of 35-39 (79.6%) or 40 or greater (76.8%) (Figures LI 81, 82, and 83). Survival was similar between metropolitan and non-metropolitan residents (Figure LI 84).

Five-year graft survival among living donor liver transplant recipients was higher among patients with a MELD score 14 or lower (81.5%), compared with MELD 15-24 (79.9%) and 25-34 (69.0%) (Figure LI 76). In terms of patient survival, however, 5-year outcomes were similar between those with a MELD score 14 or lower and those with a MELD score 15-24 (85.6% vs 85.1%) and lower for those with a MELD score 25-34 (75.9%) (Figure LI 88). Five-year graft and patient survival were highest for living donor recipients with cholestatic liver disease and nonalcoholic steatohepatitis, and lowest for those with HCC (Figures LI 75 and 86).

2 PEDIATRIC LIVER TRANSPLANTATION IN THE UNITED STATES

2.1 Summary

In 2021, 36 children died on the waiting list or were removed for being too sick to undergo transplant. While living donor recipients have better long-term graft and patient survival compared with deceased donor recipients, the proportion of children undergoing living donor transplant (15.4%) has not changed significantly in the past decade, nor has the use of split liver grafts (16.6%). With 83.4% of pediatric liver transplants using whole or partial liver grafts, candidates younger than 1 year continued to have the highest pretransplant mortality rates, which has also not changed over the past decade. Pediatric liver transplant candidates were prioritized for pediatric donors as part of the acuity circles policy implemented in February 2020. This policy allowed offers to be prioritized for children nationally before being offered to adults within a 500–nautical mile acuity circle. Since this policy change, pediatric waitlist mortality in 2020 and 2021 decreased to its lowest rate since 2011. (Simultaneously, in 2020 and 2021, adult waitlist pretransplant mortality rates remained stable despite this policy change.) While long-term patient survival continues to improve, 12% of pediatric liver transplant recipients who underwent transplant in 2011 did not survive to 2021. In 2021, the pretransplant mortality rate for Black children improved to its lowest value since 2014, although this metric does not capture the barriers to transplant evaluation and listing for non-White children. In addition, use of exception narratives, access to living donor transplant, and graft and patient survival data were not further stratified by race. Addressing racial disparities in pediatric liver transplantation is critical to ensuring equitable access and outcomes for all children requiring liver transplant.

2.2 Waiting List

In 2021, 666 new registrants were added to the pediatric liver transplant waiting list (Figure LI 90, Table LI 12). Registrants aged 1-5 years (32.9%) and 12-17 years (22%) in the year 2021 made up the largest age groups, followed by younger than 1 year (19%), 6-11 years (18.1%), and 18 years or older (8.1%) (Figure LI 92). In terms of race and ethnicity, White registrants continued to make up the largest group on the waiting list in 2021 (48.3%), followed by Hispanic (24.5%), Black (17.1%), and Asian registrants (6.5%) (Figure LI 92). For pediatric liver waitlist registrants, from 2011 to 2021, age, sex, race, diagnosis, and geographic distributions did not change substantially (Tables LI 9 and 10). Waiting time has improved in the past decade. In 2021, 29.2% of candidates waited fewer than 90 days, 24.4% waited 3-12 months, 12.7% waited 1-2 years, and 33.7% waited 2 or more years until transplant (Table LI 11).

Pretransplant mortality remained steady at a rate of 5.6 deaths per 100 patient-years in 2021, with the highest mortality rate remaining for candidates younger than 1 year at a rate of 21.7 deaths per 100 patient-years (Figures LI 100 and 101). In 2021, more registrants died on the waiting list (n=20, 3.0%) compared with 2020 (n=17, 2.5%), 12.7% were removed because their condition improved, and 2.4% were considered too sick for transplant. In total in 2021, 36 children died on the waiting list or were removed for being too sick for transplant (Table LI 13). Pretransplant mortality rates were highest in Hispanic registrants (Figure LI 102).

2.3 Transplants

In 2021, 501 pediatric liver transplants were performed in the United States compared with 502 in 2020 and 551 in 2019. The number of annual liver transplants in 2020 and 2021 remained the lowest of the past decade (Figure LI 104), perhaps partially attributable to the COVID-19 pandemic. The overall number of pediatric transplants increased for 1- to 5-year-olds and decreased for 12- to 17-year-olds, reversing the previous year’s trend (Figure LI 106). Recipient demographic information, including age at the time of transplant, race or ethnicity, insurance type, and geography, has remained similar over the past decade (Table LI 14). Biliary atresia remains the leading indication for transplant (40.9%) followed by other/unknown diagnosis (22%), metabolic (13%), acute liver failure (10.8%), other cholestatic condition (7%), and hepatoblastoma (6.4%), which remains relatively unchanged over the past decade (Table LI 15). In 2021, no patients received a DCD graft (Table LI 16).

Over the past decade, there has been no significant change in living donor transplants, which accounted for 15.4% of total transplants in 2021 (Figure LI 105). There has additionally been no increase in the use of technical variant grafts over the past decade, and in 2021 61.1% were whole liver, 22.4% were partial liver, and 16.6% were split liver transplants (Figure LI 107, Table LI 16). The plurality of recipients (42%) underwent transplant at a MELD/PELD score of 25 or greater, of which 9.6% underwent transplant at a MELD/PELD score of 40 or greater. The number of recipients who underwent transplant at status 1B (16.8%) or 1A (14.2%) has not changed significantly over the past decade (Table LI 15).

In 2021, 62.3% of pediatric liver transplant recipients received no induction therapy (Figure LI 108). The most common initial immunosuppression regimens were tacrolimus and steroids (39.9%) followed by tacrolimus, mycophenolate agent, and steroids (34.7%) (Figure LI 109).

2.4 Outcomes

Within 1 year of transplant, 19%-24% of transplant recipients had at least one episode of rejection, with the highest incidence in recipients younger than 1 year (Figure LI 116). By 5 years posttransplant, 3.7% of recipients developed posttransplant lymphoproliferative disorder (Figure LI 117).

Graft failure occurred in 5.9% of deceased donor recipients at 6 months, 6.9% at 1 year, 11.4% at 3 years, 15.3% at 5 years, and 21.0% at 10 years from transplant (Figure LI 110). Fewer living donor recipients developed graft failure, occurring in 3.0% at 6 months, 6.1% at 1 year, 9.7% at 3 years, 8.1% at 5 years, and 10.2% at 10 years from transplant (Figure LI 111), compared with deceased donor recipients. Five-year graft survival was highest for deceased donor recipients who were aged 6-11 years at the time of transplant (91.7%) followed by 12-17 years (85.0%), younger than 1 year (83.9%), and 1-5 years (82.3%) (Figure LI 112). By diagnosis, 5-year graft survival was highest for deceased donor recipients with metabolic conditions (90.6%), followed by biliary atresia (89.3%), acute liver failure (82.4%), other/unknown (80.2%), hepatoblastoma (78.2%), and other cholestatic conditions (77.6%) (Figure LI 113). Deceased donor recipients who underwent transplant at a MELD/PELD score of 35-39 had the lowest 5-year graft survival at 70.3% (Figure LI 114). At all time points, living donor recipients had better graft survival compared with deceased donor recipients, with a 5-year graft survival of 91.2% compared with 84.8%, respectively (Figure LI 115).

Recipient mortality remains notable with death occurring in 5.2% of deceased and living donor recipients at 6 months, 6.4% at 1 year, 6.9% at 3 years, 10.1% at 5 years, and 11.9% at 10 years from transplant. Since 2018, deaths at 6 months and 1 year posttransplant are now increasing (Figure LI 118). Five-year patient survival was highest for recipients who were aged 6-11 years at the time of transplant (92.8%), followed by younger than 1 year (91.4%), 12-17 years (88.8%), and 1-5 years (87.8%), for deceased donor recipients (Figure LI 120). By diagnosis, 5-year patient survival was highest for deceased donor recipients with biliary atresia (94.8%), followed by metabolic conditions (94.1%), acute liver failure (89.4%), other/unknown (85.5%), hepatoblastoma (82.3%), and other cholestatic (80.6%) (Figure LI 121). At all time points, living donor recipients had better patient survival compared with deceased donor recipients, with a 5-year patient survival of 95.3% compared with 89.7%, respectively (Figure LI 122).

This publication was produced for the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), by Hennepin Healthcare Research Institute (HHRI) and the United Network for Organ Sharing (UNOS) under contracts HHSH75R60220C00011 and HHSH250201900001C, respectively.

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Suggested Citations:
Full citation: Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2021 Annual Data Report. U.S. Department of Health and Human Services, Health Resources and Services Administration; 2023. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Abbreviated citation: OPTN/SRTR 2021 Annual Data Report. HHS/HRSA; 2023. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx

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This report is available at https://srtr.transplant.hrsa.gov. Individual chapters may be downloaded.

List of Figures

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 last laboratory MELD score 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: Overall deceased donor liver transplant rates among adult waitlist candidates
Figure LI 12: Deceased donor liver transplant rates among adult waitlist candidates by age
Figure LI 13: Deceased donor liver transplant rates among adult waitlist candidates by race
Figure LI 14: Deceased donor liver transplant rates among adult waitlist candidates by blood type
Figure LI 15: Deceased donor liver transplant rates among adult waitlist candidates by HCC exception status
Figure LI 16: Deceased donor liver transplant rates among adult waitlist candidates by sex
Figure LI 17: Deceased donor liver transplant rates among adult waitlist candidates by metropolitan vs. non-metropolitan residence
Figure LI 18: Three-year outcomes for adults waiting for liver transplant, new listings in 2016-2018
Figure LI 19: Percentage of adults who underwent deceased donor liver transplant within a given period of listing
Figure LI 20: Overall pretransplant mortality rates among adults waitlisted for liver transplant
Figure LI 21: Pretransplant mortality rates among adults waitlisted for liver transplant by age
Figure LI 22: Pretransplant mortality rates among adults waitlisted for liver transplant by race
Figure LI 23: Pretransplant mortality rates among adults waitlisted for liver transplant by sex
Figure LI 24: Pretransplant mortality rates among adults waitlisted for liver transplant by diagnosis
Figure LI 25: Pretransplant mortality rates among adults waitlisted for liver transplant by metropolitan vs. non-metropolitan residence
Figure LI 26: Pretransplant mortality rates among adults waitlisted for liver transplant by first laboratory MELD score in the year
Figure LI 27: Pretransplant mortality rates among adults waitlisted for liver by HCC exception status
Figure LI 28: Pretransplant mortality rates among adults waitlisted for liver transplant in 2021 by DSA
Figure LI 29: Deaths within six months after removal among adult liver waitlist candidates, overall
Figure LI 30: Deaths within six months after removal among adult liver waitlist candidates, by laboratory MELD score at removal
Figure LI 31: Deaths within six months after removal among adult liver waitlist candidates, by age
Figure LI 32: Overall deceased liver donor count
Figure LI 33: Deceased liver donor count by age
Figure LI 34: Deceased liver donor count by HCV status
Figure LI 35: Distribution of deceased liver donors by age
Figure LI 36: Distribution of deceased liver donors by sex
Figure LI 37: Distribution of deceased liver donors by race
Figure LI 38: Distribution of deceased liver donors by donor HCV status
Figure LI 39: Overall percent of livers recovered for transplant and not transplanted
Figure LI 40: Percent of livers recovered for transplant and not transplanted by donor age
Figure LI 41: Percent of livers recovered for transplant and not transplanted by donor sex
Figure LI 42: Percent of livers recovered for transplant and not transplanted by donor race
Figure LI 43: Percent of livers recovered for transplant and not transplanted by donor cause of death
Figure LI 44: Percent of livers recovered for transplant and not transplanted by donor HCV status
Figure LI 45: Percent of livers recovered for transplant and not transplanted, by donor risk of disease transmission
Figure LI 46: Percent of livers recovered for transplant and not transplanted by DCD status
Figure LI 47: Cause of death among deceased liver donors
Figure LI 48: Number of living liver transplants by donor relation
Figure LI 49: Living liver donors by age
Figure LI 50: Living liver donors by sex
Figure LI 51: Living liver donors by race
Figure LI 52: Living donor liver transplant graft type
Figure LI 53: BMI among living liver donors
Figure LI 54: Overall liver transplants
Figure LI 55: Total liver transplants by donor type
Figure LI 56: Total liver transplants by age
Figure LI 57: Total liver transplants by sex
Figure LI 58: Total liver transplants by race
Figure LI 59: Total liver transplants by diagnosis
Figure LI 60: Total liver transplants by simultaneous liver-kidney (SLK)
Figure LI 61: Induction agent use in adult liver transplant recipients
Figure LI 62: Immunosuppression regimen use in adult liver transplant recipients
Figure LI 63: Graft failure among adult deceased donor liver transplant recipients
Figure LI 64: Graft failure among adult living donor liver transplant recipients
Figure LI 65: Patient death among adult liver transplant recipients
Figure LI 66: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by age
Figure LI 67: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by diagnosis
Figure LI 68: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by laboratory MELD score
Figure LI 69: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by DCD status
Figure LI 70: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by HCC status
Figure LI 71: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by BMI
Figure LI 72: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence
Figure LI 73: Graft survival among adult living donor liver transplant recipients, 2014-2016, by age
Figure LI 74: Graft survival among adult living donor liver transplant recipients, 2014-2016, by race
Figure LI 75: Graft survival among adult living donor liver transplant recipients, 2014-2016, by diagnosis
Figure LI 76: Graft survival among adult living donor liver transplant recipients, 2014-2016, by laboratory MELD score
Figure LI 77: Graft survival among adult living donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence
Figure LI 78: Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by age
Figure LI 79: Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by induction agent
Figure LI 80: Incidence of PTLD among adult liver transplant recipients by recipient EBV status at transplant, 2010-2016
Figure LI 81: Patient survival among adult deceased donor liver transplant recipients, 2014-2016, by age
Figure LI 82: Patient survival among adult deceased donor liver transplant recipients, 2014-2016, by diagnosis
Figure LI 83: Patient survival among adult deceased donor liver transplant recipients, 2014-2016, by laboratory MELD score
Figure LI 84: Patient survival among adult deceased donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence
Figure LI 85: Patient survival among adult living donor liver transplant recipients, 2014-2016, by age
Figure LI 86: Patient survival among adult living donor liver transplant recipients, 2014-2016, by diagnosis
Figure LI 87: Patient survival among adult living donor liver transplant recipients, 2014-2016, by race
Figure LI 88: Patient survival among adult living donor liver transplant recipients, 2014-2016, by laboratory MELD score
Figure LI 89: Patient survival among adult living donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence
Figure LI 90: New pediatric candidates added to the liver transplant waiting list
Figure LI 91: All pediatric candidates on the liver transplant waiting list
Figure LI 92: Distribution of pediatric candidates waiting for liver transplant by age
Figure LI 93: Distribution of pediatric candidates waiting for liver transplant by race
Figure LI 94: Distribution of pediatric candidates waiting for liver transplant by sex
Figure LI 95: Three-year outcomes for newly listed pediatric candidates waiting for liver transplant, 2016-2018
Figure LI 96: Overall deceased donor liver transplant rates among pediatric waitlist candidates
Figure LI 97: Deceased donor liver transplant rates among pediatric waitlist candidates by age
Figure LI 98: Deceased donor liver transplant rates among pediatric waitlist candidates by race
Figure LI 99: Deceased donor liver transplant rates among pediatric waitlist candidates by metropolitan vs. non-metropolitan residence
Figure LI 100: Overall pretransplant mortality rates among pediatric candidates waitlisted for liver
Figure LI 101: Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by age
Figure LI 102: Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by race
Figure LI 103: Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by metropolitan vs. non-metropolitan residence
Figure LI 104: Overall pediatric liver transplants
Figure LI 105: Pediatric liver transplants by donor type
Figure LI 106: Pediatric liver transplants by recipient age
Figure LI 107: Split or partial liver transplants in children
Figure LI 108: Induction agent use in pediatric liver transplant recipients
Figure LI 109: Immunosuppression regimen use in pediatric liver transplant recipients
Figure LI 110: Graft failure among pediatric deceased donor liver transplant recipients
Figure LI 111: Graft failure among pediatric living donor liver transplant recipients
Figure LI 112: Graft survival among pediatric deceased donor liver transplant recipients, 2014-2016, by age
Figure LI 113: Graft survival among pediatric deceased donor liver transplant recipients, 2014-2016, by diagnosis
Figure LI 114: Graft survival among pediatric deceased donor liver transplant recipients, 2014-2016, by laboratory MELD score
Figure LI 115: Graft survival among pediatric liver transplant recipients, 2014-2016, by donor type
Figure LI 116: Incidence of acute rejection by 1 year posttransplant among pediatric liver transplant recipients by age
Figure LI 117: Incidence of PTLD among pediatric liver transplant recipients by recipient EBV status at transplant, 2010-2016
Figure LI 118: Patient death among pediatric liver transplant recipients
Figure LI 119: Overall patient survival among pediatric deceased donor liver transplant recipients, 2014-2016
Figure LI 120: Patient survival among pediatric deceased donor liver transplant recipients, 2014-2016, by recipient age
Figure LI 121: Patient survival among pediatric deceased donor liver transplant recipients, 2014-2016, by diagnosis
Figure LI 122: Patient survival among pediatric liver transplant recipients, 2014-2016, by donor type

List of Tables

Table LI 1: Demographic characteristics of adults on the liver transplant waiting list on December 31, 2011, and December 31, 2021
Table LI 2: Clinical characteristics of adults on the liver transplant waiting list on December 31, 2011, and December 31, 2021
Table LI 3: Listing characteristics of adults on the liver transplant waiting list on December 31, 2011, and December 31, 2021
Table LI 4: Liver transplant waitlist activity among adults
Table LI 5: Removal reason among adult liver transplant candidates
Table LI 6: Demographic characteristics of adult liver transplant recipients, 2011 and 2021
Table LI 7: Clinical characteristics of adult liver transplant recipients, 2011 and 2021
Table LI 8: Transplant characteristics of adult liver transplant recipients, 2011 and 2021
Table LI 9: Demographic characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2011, and December 31, 2021
Table LI 10: Clinical characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2011, and December 31, 2021
Table LI 11: Listing characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2011, and December 31, 2021
Table LI 12: Liver transplant waitlist activity among pediatric candidates
Table LI 13: Removal reason among pediatric liver transplant candidates
Table LI 14: Demographic characteristics of pediatric liver transplant recipients, 2011 and 2021
Table LI 15: Clinical characteristics of pediatric liver transplant recipients, 2011 and 2021
Table LI 16: Transplant characteristics of pediatric liver transplant recipients, 2011 and 2021

**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.

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.

**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.

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.

**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. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

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. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

**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.

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.

**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.

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.

**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. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

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. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

**Distribution of adults waiting for liver transplant by last laboratory MELD score 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.

Figure LI 7: Distribution of adults waiting for liver transplant by last laboratory MELD score 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.

**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.

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.

**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.

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.

**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.

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.

**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.

Figure LI 11: 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.

**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. Age is determined at the later of listing date or January 1 of the given year.

Figure LI 12: 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. Age is determined at the later of listing date or January 1 of the given year.

**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.

Figure LI 13: 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.

**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.

Figure LI 14: 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.

**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. HCC is determined at the later of listing date and January 1 of the year. HCC, hepatocellular carcinoma.

Figure LI 15: 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. HCC is determined at the later of listing date and January 1 of the year. HCC, hepatocellular carcinoma.

**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.

Figure LI 16: 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.

**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.

Figure LI 17: 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.

**Three-year outcomes for adults waiting for liver transplant, new listings in 2016-2018.** 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 18: Three-year outcomes for adults waiting for liver transplant, new listings in 2016-2018. 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.

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

Figure LI 19: Percentage of adults who underwent deceased donor liver transplant within a given period of listing. Candidates listed at more than one center are counted once per listing.

**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.

Figure LI 20: 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.

**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. Age is determined at the later of listing date or January 1 of the given year.

Figure LI 21: 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. Age is determined at the later of listing date or January 1 of the given year.

**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.

Figure LI 22: 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.

**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.

Figure LI 23: 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.

**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. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

Figure LI 24: 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. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

**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.

Figure LI 25: 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.

**Pretransplant mortality rates among adults waitlisted for liver transplant by first laboratory MELD score 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.

Figure LI 26: Pretransplant mortality rates among adults waitlisted for liver transplant by first laboratory MELD score 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.

**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. HCC is determined at the later of listing date and January 1 of the year. HCC, hepatocellular carcinoma.

Figure LI 27: 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. HCC is determined at the later of listing date and January 1 of the year. HCC, hepatocellular carcinoma.

**Pretransplant mortality rates among adults waitlisted for liver transplant in 2021 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.

Figure LI 28: Pretransplant mortality rates among adults waitlisted for liver transplant in 2021 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.

**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.

Figure LI 29: 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.

**Deaths within six months after removal among adult liver waitlist candidates, by laboratory MELD score at removal.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure LI 30: Deaths within six months after removal among adult liver waitlist candidates, by laboratory MELD score at removal. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

**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. Age is determined at removal.

Figure LI 31: 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. Age is determined at removal.

Figure LI 32: Overall deceased liver donor count. Count of deceased donors whose livers were recovered for transplant.

Figure LI 33: Deceased liver donor count by age. Count of deceased donors whose livers were recovered for transplant.

**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. HCV, hepatitis C virus.

Figure LI 34: 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. HCV, hepatitis C virus.

Figure LI 35: Distribution of deceased liver donors by age. Deceased donors whose livers were recovered for transplant.

Figure LI 36: Distribution of deceased liver donors by sex. Deceased donors whose livers were recovered for transplant.

Figure LI 37: Distribution of deceased liver donors by race. Deceased donors whose livers were recovered for transplant.

**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. HCV, hepatitis C virus.

Figure LI 38: 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. HCV, hepatitis C virus.

**Overall percent of livers recovered for transplant and not transplanted.** Percentages of livers not transplanted out of all livers recovered for transplant.

Figure LI 39: Overall percent of livers recovered for transplant and not transplanted. Percentages of livers not transplanted out of all livers recovered for transplant.

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

Figure LI 40: Percent of livers recovered for transplant and not transplanted by donor age. Percentages of livers not transplanted out of all livers recovered for transplant.

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

Figure LI 41: Percent of livers recovered for transplant and not transplanted by donor sex. Percentages of livers not transplanted out of all livers recovered for transplant.

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

Figure LI 42: Percent of livers recovered for transplant and not transplanted by donor race. Percentages of livers not transplanted out of all livers recovered for transplant.

**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.

Figure LI 43: 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.

**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. HCV, hepatitis C virus.

Figure LI 44: 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. HCV, hepatitis C virus.

**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.

Figure LI 45: 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.

**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.

Figure LI 46: 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.

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

Figure LI 47: Cause of death among deceased liver donors. Deceased donors with a liver recovered for the purposes of transplant. CVA, cerebrovascular accident.

**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.

Figure LI 48: 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.

Figure LI 49: Living liver donors by age. As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.

Figure LI 50: Living liver donors by sex. As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.

$**Living liver donors by race.** As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.$

Figure LI 51: Living liver donors by race. As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.

Figure LI 52: Living donor liver transplant graft type. As reported on the OPTN Living Donor Registration Form.

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

Figure LI 53: BMI among living liver donors. Donor height and weight reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.

**Overall liver transplants.** All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure LI 54: Overall liver transplants. All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

**Total liver transplants by donor type.** All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure LI 55: Total liver transplants by donor type. All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

**Total liver transplants by age.** All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure LI 56: Total liver transplants by age. All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

**Total liver transplants by sex.** All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure LI 57: Total liver transplants by sex. All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

**Total liver transplants by race.** All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure LI 58: Total liver transplants by race. All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

**Total liver transplants by diagnosis.** All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

Figure LI 59: Total liver transplants by diagnosis. All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

**Total liver transplants by simultaneous liver-kidney (SLK).** All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients. Simultaneous liver-kidney transplants are recipients with a liver and kidney transplant from the same donor.

Figure LI 60: Total liver transplants by simultaneous liver-kidney (SLK). All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients. Simultaneous liver-kidney transplants are recipients with a liver and kidney transplant from the same donor.

Figure LI 61: Induction agent use in adult liver transplant recipients. Immunosuppression at transplant reported to the OPTN.

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

Figure LI 62: Immunosuppression regimen use in adult liver transplant recipients. Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, all mycophenolate agents.

**Graft failure among adult deceased donor liver transplant recipients.** All adult recipients of deceased donor livers, including multiorgan transplants.

Figure LI 63: Graft failure among adult deceased donor liver transplant recipients. All adult recipients of deceased donor livers, including multiorgan transplants.

**Graft failure among adult living donor liver transplant recipients.** All adult recipients of living donor livers, including multiorgan transplants.

Figure LI 64: Graft failure among adult living donor liver transplant recipients. All adult recipients of living donor livers, including multiorgan transplants.

**Patient death among adult liver transplant recipients.** All adult recipients of deceased donor livers, including multiorgan transplants.

Figure LI 65: Patient death among adult liver transplant recipients. All adult recipients of deceased donor livers, including multiorgan transplants.

**Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by age.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 66: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by age. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by diagnosis.** Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

Figure LI 67: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by diagnosis. Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

**Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by laboratory MELD score.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 68: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by laboratory MELD score. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by DCD status.** Graft survival estimated using unadjusted Kaplan-Meier methods. DCD, donation after circulatory death; DBD, donation after brain death.

Figure LI 69: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by DCD status. Graft survival estimated using unadjusted Kaplan-Meier methods. DCD, donation after circulatory death; DBD, donation after brain death.

$**Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by HCC status.** Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma.$

Figure LI 70: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by HCC status. Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma.

**Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by BMI.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 71: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by BMI. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 72: Graft survival among adult deceased donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among adult living donor liver transplant recipients, 2014-2016, by age.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 73: Graft survival among adult living donor liver transplant recipients, 2014-2016, by age. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among adult living donor liver transplant recipients, 2014-2016, by race.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 74: Graft survival among adult living donor liver transplant recipients, 2014-2016, by race. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among adult living donor liver transplant recipients, 2014-2016, by diagnosis.** Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

Figure LI 75: Graft survival among adult living donor liver transplant recipients, 2014-2016, by diagnosis. Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

**Graft survival among adult living donor liver transplant recipients, 2014-2016, by laboratory MELD score.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 76: Graft survival among adult living donor liver transplant recipients, 2014-2016, by laboratory MELD score. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among adult living donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 77: Graft survival among adult living donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence. Graft survival estimated using unadjusted Kaplan-Meier methods.

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

Figure LI 78: Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by age. Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

**Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by induction agent.** Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure LI 79: Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by induction agent. Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

**Incidence of PTLD among adult liver transplant recipients by recipient EBV status at transplant, 2010-2016.** 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.

Figure LI 80: Incidence of PTLD among adult liver transplant recipients by recipient EBV status at transplant, 2010-2016. 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 among adult deceased donor liver transplant recipients, 2014-2016, by age.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 81: Patient survival among adult deceased donor liver transplant recipients, 2014-2016, by age. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult deceased donor liver transplant recipients, 2014-2016, by diagnosis.** Patient survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

Figure LI 82: Patient survival among adult deceased donor liver transplant recipients, 2014-2016, by diagnosis. Patient survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

**Patient survival among adult deceased donor liver transplant recipients, 2014-2016, by laboratory MELD score.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 83: Patient survival among adult deceased donor liver transplant recipients, 2014-2016, by laboratory MELD score. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult deceased donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 84: Patient survival among adult deceased donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult living donor liver transplant recipients, 2014-2016, by age.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 85: Patient survival among adult living donor liver transplant recipients, 2014-2016, by age. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult living donor liver transplant recipients, 2014-2016, by diagnosis.** Patient survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

Figure LI 86: Patient survival among adult living donor liver transplant recipients, 2014-2016, by diagnosis. Patient survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.

**Patient survival among adult living donor liver transplant recipients, 2014-2016, by race.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 87: Patient survival among adult living donor liver transplant recipients, 2014-2016, by race. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult living donor liver transplant recipients, 2014-2016, by laboratory MELD score.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 88: Patient survival among adult living donor liver transplant recipients, 2014-2016, by laboratory MELD score. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult living donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 89: Patient survival among adult living donor liver transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence. Patient survival estimated using unadjusted Kaplan-Meier methods.

**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.

Figure LI 90: 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.

**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.

Figure LI 91: 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.

**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. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure LI 92: 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. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

**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.

Figure LI 93: 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.

**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.

Figure LI 94: 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.

**Three-year outcomes for newly listed pediatric candidates waiting for liver transplant, 2016-2018.** Pediatric candidates who joined the waiting list in 2016-2018. Candidates listed at more than one center are counted once per listing. DD, deceased donor; LD, living donor.

Figure LI 95: Three-year outcomes for newly listed pediatric candidates waiting for liver transplant, 2016-2018. Pediatric candidates who joined the waiting list in 2016-2018. Candidates listed at more than one center are counted once per listing. DD, deceased donor; LD, living donor.

**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.

Figure LI 96: 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.

**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. Age is determined at the later of listing date or January 1 of the given year.

Figure LI 97: 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. Age is determined at the later of listing date or January 1 of the given year.

**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.

Figure LI 98: 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.

**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.

Figure LI 99: 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.

**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.

Figure LI 100: 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.

**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. Age is determined at the later of listing date or January 1 of the given year.

Figure LI 101: 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. Age is determined at the later of listing date or January 1 of the given year.

**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.

Figure LI 102: 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.

**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.

Figure LI 103: 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.

**Overall pediatric liver transplants.** All pediatric liver transplant recipients, including retransplant, and multiorgan recipients.

Figure LI 104: Overall pediatric liver transplants. All pediatric liver transplant recipients, including retransplant, and multiorgan recipients.

**Pediatric liver transplants by donor type.** All pediatric liver transplant recipients, including retransplant, and multiorgan recipients.

Figure LI 105: Pediatric liver transplants by donor type. All pediatric liver transplant recipients, including retransplant, and multiorgan recipients.

**Pediatric liver transplants by recipient age.** All pediatric liver transplant recipients, including retransplant, and multiorgan recipients.

Figure LI 106: Pediatric liver transplants by recipient age. All pediatric liver transplant recipients, including retransplant, and multiorgan recipients.

Figure LI 107: Split or partial liver transplants in children. Percent of transplants from a split liver.

Figure LI 108: Induction agent use in pediatric liver transplant recipients. Immunosuppression at transplant reported to the OPTN.

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

Figure LI 109: Immunosuppression regimen use in pediatric liver transplant recipients. Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, all mycophenolate agents.

**Graft failure among pediatric deceased donor liver transplant recipients.** All pediatric recipients of deceased donor livers, including multiorgan 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 is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.

Figure LI 110: Graft failure among pediatric deceased donor liver transplant recipients. All pediatric recipients of deceased donor livers, including multiorgan 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 is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.

**Graft failure among pediatric living donor liver transplant recipients.** All pediatric recipients of living donor livers, including multiorgan 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 is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.

Figure LI 111: Graft failure among pediatric living donor liver transplant recipients. All pediatric recipients of living donor livers, including multiorgan 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 is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.

**Graft survival among pediatric deceased donor liver transplant recipients, 2014-2016, by age.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 112: Graft survival among pediatric deceased donor liver transplant recipients, 2014-2016, by age. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among pediatric deceased donor liver transplant recipients, 2014-2016, by diagnosis.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 113: Graft survival among pediatric deceased donor liver transplant recipients, 2014-2016, by diagnosis. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among pediatric deceased donor liver transplant recipients, 2014-2016, by laboratory MELD score.** Graft survival estimated using unadjusted Kaplan-Meier methods. Pediatric candidates aged 12 to 17 years can be assigned MELD or PELD scores.

Figure LI 114: Graft survival among pediatric deceased donor liver transplant recipients, 2014-2016, by laboratory MELD score. Graft survival estimated using unadjusted Kaplan-Meier methods. Pediatric candidates aged 12 to 17 years can be assigned MELD or PELD scores.

**Graft survival among pediatric liver transplant recipients, 2014-2016, by donor type.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 115: Graft survival among pediatric liver transplant recipients, 2014-2016, by donor type. Recipient survival estimated using unadjusted Kaplan-Meier methods.

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

Figure LI 116: Incidence of acute rejection by 1 year posttransplant among pediatric liver transplant recipients by age. Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

$**Incidence of PTLD among pediatric liver transplant recipients by recipient EBV status at transplant, 2010-2016.** Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus. PTLD, posttransplant lymphoproliferative disorder.$

Figure LI 117: Incidence of PTLD among pediatric liver transplant recipients by recipient EBV status at transplant, 2010-2016. 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. PTLD, posttransplant lymphoproliferative disorder.

**Patient death among pediatric liver transplant recipients.** All pediatric recipients of deceased donor livers, including multiorgan transplants. Estimates are unadjusted, computed using unadjusted Kaplan-Meier methods.

Figure LI 118: Patient death among pediatric liver transplant recipients. All pediatric recipients of deceased donor livers, including multiorgan transplants. Estimates are unadjusted, computed using unadjusted Kaplan-Meier methods.

**Overall patient survival among pediatric deceased donor liver transplant recipients, 2014-2016.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 119: Overall patient survival among pediatric deceased donor liver transplant recipients, 2014-2016. Recipient survival estimated using unadjusted Kaplan-Meier methods.

$**Patient survival among pediatric deceased donor liver transplant recipients, 2014-2016, by recipient age.** Recipient survival estimated using unadjusted Kaplan-Meier methods.$

Figure LI 120: Patient survival among pediatric deceased donor liver transplant recipients, 2014-2016, by recipient age. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among pediatric deceased donor liver transplant recipients, 2014-2016, by diagnosis.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 121: Patient survival among pediatric deceased donor liver transplant recipients, 2014-2016, by diagnosis. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among pediatric liver transplant recipients, 2014-2016, by donor type.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 122: Patient survival among pediatric liver transplant recipients, 2014-2016, by donor type. Recipient survival estimated using unadjusted Kaplan-Meier methods.

Characteristic	2011 N	2011 Percent	2021 N	2021 Percent
Age (years)
18-34 years	691	4.3	574	5.1
35-49	2,521	15.6	1,906	16.8
50-64	10,422	64.4	5,612	49.5
65+	2,540	15.7	3,246	28.6
Sex
Male	10,068	62.2	6,894	60.8
Female	6,106	37.8	4,444	39.2
Race
White	11,357	70.2	7,637	67.4
Black	1,139	7.0	757	6.7
Asian	788	4.9	598	5.3
Hispanic	2,728	16.9	2,174	19.2
Other	162	1.0	172	1.5
Geography
Metropolitan	13,550	83.8	9,663	85.2
Non-metropolitan	2,421	15.0	1,563	13.8
Missing	203	1.3	112	1.0
Miles between candidate to center
<50 miles	9,168	56.7	6,676	58.9
50-<100	2,744	17.0	2,019	17.8
100-<150	1,446	8.9	957	8.4
150-<250	1,334	8.2	888	7.8
250+	1,345	8.3	715	6.3
Missing	137	0.8	83	0.7
All candidates
All candidates	16,174	100.0	11,338	100.0

Characteristic	2011 N	2011 Percent	2021 N	2021 Percent
Diagnosis
Acute liver failure	371	2.3	132	1.2
HCV	4,944	30.6	1,110	9.8
Alcoholic liver disease	3,710	22.9	3,840	33.9
Cholestatic disease	1,502	9.3	932	8.2
HCC	849	5.2	1,259	11.1
NASH	1,227	7.6	2,175	19.2
Other/unknown	3,571	22.1	1,890	16.7
Blood Type
A	6,146	38.0	4,401	38.8
AB	391	2.4	236	2.1
B	1,781	11.0	1,166	10.3
O	7,856	48.6	5,535	48.8
Urgency Status
14 or lower	8,112	50.2	4,762	42.0
15-24	4,060	25.1	2,958	26.1
25-34	994	6.1	1,035	9.1
35-39	35	0.2	34	0.3
40+	26	0.2	15	0.1
Status 1A	2	0.0	5	0.0
Inactive	2,925	18.1	2,529	22.3
Missing	20	0.1	0	0
HCC status for liver candidates
No HCC Exception	14,941	92.4	9,604	84.7
HCC Exception	1,213	7.5	1,734	15.3
Missing	20	0.1	0	0
All candidates
All candidates	16,174	100.0	11,338	100.0

Characteristic	2011 N	2011 Percent	2021 N	2021 Percent
Previous transplant
No prior transplant	15,725	97.2	11,066	97.6
Prior transplant	449	2.8	272	2.4
Waiting time
<90 days	2,087	12.9	1,913	16.9
3-<6 months	1,560	9.6	1,523	13.4
6-<12 months	2,370	14.7	2,056	18.1
1-<2 years	3,018	18.7	2,154	19.0
2+ years	7,139	44.1	3,692	32.6
All candidates
All candidates	16,174	100.0	11,338	100.0

Waiting list state	2019	2020	2021
Waiting list state
Patients at start of year	13,115	12,551	11,771
Patients added during year	12,761	12,401	13,165
Patients removed during year	13,324	13,179	13,598
Patients at end of year	12,552	11,773	11,338

Removal reason	2019	2020	2021
Removal reason
Deceased donor transplant	7,868	7,930	8,212
Living donor transplant	442	425	492
Transplant outside US	1	1	1
Patient died	1,213	1,117	1,134
Patient refused transplant	117	121	135
Improved, transplant not needed	890	902	1,051
Too sick for transplant	1,188	1,226	1,177
Other	1,602	1,452	1,387
Still on waiting list	3	5	9

**Table LI 6:** **Demographic characteristics of adult liver transplant recipients, 2011 and 2021.** Liver transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.
Characteristic	2011 N	2011 Percent	2021 N	2021 Percent
Recipient age (years)
18-34 years	349	6.0	696	8.0
35-49	983	16.9	1,938	22.2
50-64	3,728	64.2	4,145	47.5
65+	746	12.8	1,954	22.4
Sex
Male	3,870	66.7	5,453	62.4
Female	1,936	33.3	3,280	37.6
Race
White	4,042	69.6	6,169	70.6
Black	610	10.5	605	6.9
Asian	264	4.5	370	4.2
Hispanic	814	14.0	1,437	16.5
Other	76	1.3	152	1.7
Body mass index
<18.5	94	1.6	178	2.0
18.5-<25	1,679	28.9	2,278	26.1
25-<30	2,001	34.5	2,784	31.9
30-<35	1,210	20.8	1,833	21.0
35+	772	13.3	1,340	15.3
Missing	50	0.9	320	3.7
Insurance
Private	3,278	56.5	4,525	51.8
Medicare	1,466	25.2	2,335	26.7
Medicaid	828	14.3	1,497	17.1
Other/unknown	234	4.0	376	4.3
Geography
Metropolitan	4,886	84.2	7,293	83.5
Non-metropolitan	809	13.9	1,289	14.8
Missing	111	1.9	151	1.7
Miles between recipient to center
<50 miles	3,302	56.9	4,959	56.8
50-<100	955	16.4	1,551	17.8
100-<150	500	8.6	849	9.7
150-<250	460	7.9	655	7.5
250+	528	9.1	618	7.1
Missing	61	1.1	101	1.2
All recipients
All recipients	5,806	100.0	8,733	100.0

**Table LI 7:** **Clinical characteristics of adult liver transplant recipients, 2011 and 2021.** Liver transplant recipients, including retransplants. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis.
Characteristic	2011 N	2011 Percent	2021 N	2021 Percent
Diagnosis
Acute liver failure	228	3.9	216	2.5
HCV	1,435	24.7	437	5.0
Alcoholic liver disease	1,014	17.5	3,460	39.6
Cholestatic disease	533	9.2	696	8.0
HCC	1,127	19.4	1,002	11.5
NASH	430	7.4	1,714	19.6
Other/unknown	1,039	17.9	1,208	13.8
Blood Type
A	2,138	36.8	3,179	36.4
AB	304	5.2	411	4.7
B	779	13.4	1,167	13.4
O	2,585	44.5	3,976	45.5
Urgency Status at transplant
14 or lower	184	3.2	638	7.3
15-24	1,931	33.3	2,402	27.5
25-34	2,408	41.5	3,501	40.1
35-39	485	8.4	1,038	11.9
40+	582	10.0	936	10.7
Status 1A	215	3.7	208	2.4
Inactive	1	0.0	8	0.1
Status 1B	0	0	2	0.0
HCC status for liver recipients
No HCC exception	4,331	74.6	7,356	84.2
HCC Exception	1,475	25.4	1,377	15.8
All recipients
All recipients	5,806	100.0	8,733	100.0

**Table LI 9:** **Demographic characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2011, and December 31, 2021.** Candidates younger than 18 years at listing waiting for transplant on December 31 of the given year, regardless of first listing date. Age is determined on December 31 of the year. Distance is computed from candidate's home zip code to the transplant center.
Characteristic	2011 N	2011 Percent	2021 N	2021 Percent
Age (years)
<1 year	59	9.2	44	11.0
1-5	171	26.6	112	27.9
6-11	141	21.9	94	23.4
12-17	164	25.5	94	23.4
18+	108	16.8	57	14.2
Sex
Male	292	45.4	191	47.6
Female	351	54.6	210	52.4
Race
White	344	53.5	189	47.1
Black	94	14.6	62	15.5
Asian	25	3.9	25	6.2
Hispanic	166	25.8	114	28.4
Other	14	2.2	11	2.7
Geography
Metropolitan	549	85.4	350	87.3
Non-metropolitan	77	12.0	42	10.5
Missing	17	2.6	9	2.2
Miles between candidate to center
<50 miles	330	51.3	187	46.6
50-<100	84	13.1	72	18.0
100-<150	55	8.6	43	10.7
150-<250	68	10.6	46	11.5
250+	93	14.5	45	11.2
Missing	13	2.0	8	2.0
All candidates
All candidates	643	100.0	401	100.0

**Table LI 14:** **Demographic characteristics of pediatric liver transplant recipients, 2011 and 2021.** Pediatric liver transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.
Characteristic	2011 N	2011 Percent	2021 N	2021 Percent
Recipient age (years)
<1 year	151	28.2	139	27.7
1-5	196	36.6	186	37.1
6-11	100	18.7	77	15.4
12-17	89	16.6	99	19.8
Sex
Male	250	46.6	242	48.3
Female	286	53.4	259	51.7
Race
White	291	54.3	247	49.3
Black	86	16.0	94	18.8
Asian	37	6.9	32	6.4
Hispanic	107	20.0	106	21.2
Other	15	2.8	22	4.4
Insurance
Private	252	47.0	202	40.3
Medicare	2	0.4	3	0.6
Medicaid	217	40.5	228	45.5
Other/unknown	65	12.1	68	13.6
Geography
Metropolitan	439	81.9	417	83.2
Non-metropolitan	78	14.6	69	13.8
Missing	19	3.5	15	3.0
Miles between recipient to center
<50 miles	246	45.9	235	46.9
50-<100	79	14.7	85	17.0
100-<150	57	10.6	44	8.8
150-<250	63	11.8	65	13.0
250+	78	14.6	59	11.8
Missing	13	2.4	13	2.6
All recipients
All recipients	536	100.0	501	100.0