OPTN/SRTR 2023 Annual Data Report: Liver

Allison J. Kwong¹, W. Ray Kim^1,2, John R. Lake^2,3, David P. Schladt², Dzhuliyana Handarova⁴, Jesse Howell⁴, Benjamin Schumacher⁴, Samantha Weiss⁴, Jon J. Snyder^2,5,6, Ajay K. Israni^2,7

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

²Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN

³Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN

⁴Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA

⁵Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN

⁶Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN

⁷Department of Medicine, University of Texas Medical Branch, Galveston, TX

Abstract

The number of liver transplants performed in 2023 in the United States reached another record high, totaling 10,659 overall, of which 10,125 (95.0%) were in adult recipients and 534 (5.0%) were in pediatric recipients. This growth was driven by increased recovery of livers from older donors and donation after circulatory death (DCD) donors—likely related to the wider availability of machine perfusion technologies. The overall nonuse rate, or percent of livers recovered for transplant and not transplanted, was 9.7%, a decrease from the preceding years, and 16.7% of transplant recipients accepted DCD livers. There was also growth in living donation, representing 5.7% of adult transplants and 14.6% of pediatric transplants. In July 2023, the model for end-stage liver disease (MELD) 3.0 and pediatric end-stage liver disease (PELD)–creatinine scoring systems were updated from MELD-sodium and PELD, respectively, and criteria for status 1B qualification for pediatric candidates were updated. A major goal of MELD 3.0 was to address the sex disparity in deceased donor transplant rates. In 2023, the gap in deceased donor liver transplant rates between sexes narrowed, although the rate remained higher for adult male candidates compared with female candidates, and pretransplant mortality rates were higher among adult female candidates compared with male candidates. Alcohol-associated liver disease and metabolic dysfunction–associated steatohepatitis remained the leading indications for liver transplant.

Keywords: Liver transplantation, liver donation, outcomes, waiting list

1 Introduction

As we survey the totality of the 2023 liver transplant data, we observe macro trends that may reflect the impact of recent developments in liver transplantation on pretransplant and posttransplant outcomes. Before we delve into detailed data in the body of the report, we would like to highlight three areas that may be noteworthy.

First, since the first approval by the US Food and Drug Administration in 2021, machine perfusion devices have had substantial impact on the practice and outcome of liver transplantation. Compared with the traditional cold storage method, the technology enhances organ viability, reduces the risk of ischemic injury, and allows real-time functional assessment of the graft. Its largest impact has been seen in donation after circulatory death (DCD) graft, leading to a substantial expansion of donor pools. In this year’s report, we note that removals from the waiting list for transplant among adult liver transplant candidates in the United States outpaced the number of new registrations, leaving fewer patients remaining on the list at the end of 2023. Waiting times are shorter, and there are more recipients with model for end-stage liver disease (MELD) scores of 14 or lower at the time of transplant and fewer in the higher MELD categories. The data indicate that this is not because of reduced waitlist registration, as the number of patients newly added to the list actually increased.

Second, the MELD score has been used to prioritize patients on the liver transplant waiting list since 2002. The latest version of the score, MELD 3.0, incorporates new variables including female sex and serum albumin and updates the coefficients for serum creatinine, international normalized ratio, bilirubin, and sodium. Although the pretransplant mortality rate for liver transplant candidates decreased with MELD-based organ allocation, women had experienced lower transplant rates and higher waitlist mortality. MELD 3.0 was adopted for policy implementation in July 2023. In this report, concurrent with implementation of MELD 3.0, we begin to see that the disparity in transplant rates between sexes has decreased, foretelling an encouraging impact of the new system.

The third trend, seen on a longer time scale compared with the other two, is simultaneous liver-kidney (SLK) transplant. As recognized by the inclusion of serum creatinine in the MELD score, renal dysfunction represents a vitally important extrahepatic manifestation of end-stage liver disease. In addition to having a significant impact on pretransplant mortality, renal impairment at the time of transplant also affects posttransplant outcomes, which justifies SLK in some of the liver transplant recipients. To achieve equitable use of renal allografts between kidney and liver transplant candidates, standardized medical criteria for SLK transplant were established in 2017. At the same time, a “safety net” mechanism was put in place, so that a kidney graft would be preferentially allocated in the event the renal function does not recover soon after liver transplant. In this 2023 data report, the proportion of adult SLK transplants of total liver transplants has decreased, and the number of new kidney registrations and the number of kidney transplants in adults with a previous history of liver transplant have increased since implementation of the safety net policy in 2017. The net effect may be the more judicious use of kidney allografts in patients with end-stage liver disease and improved organ utility.

2 Adult Liver Transplant

2.1 Waiting List

In 2023, there were a total of 24,492 adult liver candidates ever waiting in the United States, with a record 13,954 candidates newly added to the waiting list, an 8.5% increase over the previous year (Figure LI 1 and Figure LI 2). By the end of the year, 14,747 were removed from the list—64.5% for deceased donor liver transplant, 3.9% for living donor liver transplant, 6.4% for death, 6.6% for being too sick, 7.5% for improved condition, and 11.1% for other reasons—and 9,745 were left waiting (Table LI 4 and Table LI 5), a 7.5% decrease from the end of 2022. Compared with previous years, a greater proportion of patients were removed for transplant, and a smaller proportion were removed for death or being too sick for transplant.

Overall, adult candidates in 2023 were younger than in previous years: 6.3% were aged 18-34 years, 20.1% aged 35-49 years, 46.7% aged 50-64 years, and 26.9% aged 65 years or older (Figure LI 3). In terms of sex distribution, female candidates made up an increasing proportion of the waiting list, although still there were more male than female candidates being listed (60.6% and 39.4%, respectively) (Figure LI 4). The racial and ethnic composition was relatively unchanged: 67.8% White, 19.0% Hispanic, 6.5% Black, 4.5% Asian, 1.2% Native American, 0.6% Multiracial, and 0.3% unreported (Figure LI 5).

The most common primary diagnosis among adult waitlist candidates was alcohol-associated liver disease, with 34.9% categorized as alcohol-associated cirrhosis and 4.1% as alcohol-associated hepatitis—increases from 22.8% and 0.1% in 2013, respectively (Figure LI 6). In August 2022, the diagnosis for “alcoholic cirrhosis” was updated to “alcohol-associated cirrhosis without acute alcohol-associated hepatitis,” and the diagnosis of “alcoholic hepatitis” was updated to “acute alcohol-associated hepatitis with or without cirrhosis.” Accordingly, the prevalence of waitlisting for alcohol-associated hepatitis increased from 1.7% in 2021, to 2.1% in 2022, to the 4.1% in 2023, likely related to not only practice changes but also the updated nomenclature. In 2023, 20.4% of registrations had metabolic dysfunction–associated steatohepatitis (MASH) as the primary indication for waitlisting, an increase from 9.6% in 2013. Other specified diagnoses were less common, including hepatocellular carcinoma (HCC) (10.3%), cholestatic liver disease (7.2%), hepatitis C (6.2%), and acute liver failure (1.6%).

Most adult liver transplant candidates in 2023 were overweight by body mass index (BMI); there were 1.6% with BMI of <18.5 kg/m², 23.0% with BMI of 18.5-<25 kg/m², 33.8% with BMI of 25-<30 kg/m², 23.7% with BMI of 30-<35 kg/m², and 17.3% with BMI of 35 kg/m² or greater (Figure LI 8). The most common blood type was O (48.4%), followed by type A (38.0%), type B (10.6%), and type AB (3.1%) (Figure LI 9), mirroring the distribution of the general US population. Similar to previous years, 3.2% of candidates had a history of prior transplant (Figure LI 10).

2.2 Waitlist Outcomes

The overall deceased donor liver transplant rate for adults increased to 94.7 transplants per 100 patient-years in 2023, from 36.1 transplants per 100 patient-years in 2013 (Figure LI 11). This increase occurred across all age and racial and ethnic groups (Figure LI 12 and Figure LI 13). Candidates aged 18-34 years and 35-49 years continued to have higher deceased donor transplant rates than older candidates. White and Black candidates had higher deceased donor transplant rates than Asian or Hispanic candidates. The deceased donor liver transplant rate for patients with blood type AB (254.6 transplants per 100 patient-years) was nearly twice more than that for patients with blood type B and three times more than that for patients with blood types A or O (Figure LI 14).

Deceased donor transplant rates for adult candidates with and without HCC exception points have been similar since 2020, after many years of greater transplant access for patients with HCC and a series of policy changes lengthening their waiting time and decreasing their waitlist priority (Figure LI 15).

In July 2023, MELD 3.0 replaced MELD-sodium (MELD-Na) to represent medical urgency in the liver transplant waiting list, which was intended to address, in part, the sex disparity in deceased donor transplant rates. In 2023, with the second half of the year reflecting the policy change, the gap in adult deceased donor liver transplant rates between sexes had already started to narrow, although the rate was still higher for male candidates compared with female candidates (96.9 versus 91.4 transplants per 100 patient-years) (Figure LI 16).

Among adult candidates newly listed in 2018-2020, only 7.0% remained on the waiting list after 3 years, 58.3% received a deceased donor liver transplant, 3.3% received a living donor liver transplant, 8.6% died, and 22.8% were removed from the list for other reasons (Figure LI 17). Of candidates listed in 2022, 41.7% underwent deceased donor liver transplant within 3 months; 48.4%, within 6 months; and 58.2%, within 1 year—all increases compared with previous years (Figure LI 18). The 1-year probability of deceased donor liver transplant increased to 58.2% from 40.6% 10 years prior.

The pretransplant mortality rate among adult waitlist candidates has decreased from 16.9 to 12.9 deaths per 100 patient-years over the past decade and has been overall stable in the past several years (Figure LI 19). In 2023, female candidates still had higher pretransplant mortality rates compared with male candidates (13.9 versus 12.2 deaths per 100 patient-years); MELD 3.0 was in effect for only the latter half of the year, and height- or body size–based disparities may still have contributed (Figure LI 22). By etiology, higher pretransplant mortality rates were observed among those with alcohol-associated hepatitis (29.4 deaths per 100 patient-years), acute liver failure (21.5 deaths per 100 patient-years), and MASH (16.5 deaths per 100 patient-years) (Figure LI 23). Despite the noted allocation policy changes that have lengthened waiting time and lowered waitlist priority for patients with HCC exception points, pretransplant mortality rates remained lower for patients with an HCC exception compared to those without (11.2 versus 13.1 deaths per 100 patient-years) (Figure LI 25). Pretransplant mortality rates still varied widely across the 51 active donation service areas, with a median of 13.1 deaths per 100 patient-years (interquartile range, 10.2-17.2) and ranging from 3.9 to 39.7 deaths per 100 patient-years (Figure LI 26).

Among adults removed from the liver transplant waiting list for reasons other than transplant or death, 14.3% died within 6 months after removal (Figure LI 27). The risk of death within 6 months after removal was higher among those with MELD scores greater than 25 and patients aged 65 years or older (Figure LI 28 and Figure LI 29).

2.3 Transplants

In 2023, there were 10,125 adult liver transplant recipients, another all-time high, representing a 71% increase in the past decade (Figure LI 33). Both deceased and living donation increased, with 9,545 deceased donor and 580 living donor liver transplants performed (Figure LI 34).

Alcohol-associated liver disease continued to be the most common indication for adult liver transplant, with 41.1% of recipients having a primary diagnosis of alcohol-associated liver disease (34.6% alcohol-associated cirrhosis and 6.5% alcohol-associated hepatitis), followed by MASH at 20.3%. Other specified etiologies included HCC (10.4%), hepatitis C virus (HCV) (4.2%), cholestatic liver disease (7.4%), and acute liver failure (2.0%) (Figure LI 38 and Table LI 7). Only 14.6% of patients underwent transplant with HCC MELD exception points, a decrease from 26.4% in 2013. By urgency status, 2.1% underwent transplant as status 1A, 9.7% with an allocation MELD score of 40 or greater, 10.8% with a MELD of 35-39, 26.8% with a MELD of 25-34, 30.9% with a MELD of 15-24, and 19.5% with a MELD of 14 or lower. Compared with 2013, there were more recipients in the lowest urgency category (MELD 14 or lower) and fewer in the higher urgency categories (MELD 25 or higher). Waiting times were also shorter: 63.8% of transplant recipients waited less than 90 days, 10.8% waited 3-<6 months, 13.6% waited 6-<12 months, 7.2% waited 1-<2 years, and 4.5% waited 2 years or longer (Table LI 8).

The proportion of female adult liver transplant recipients has increased: 38.8% in 2023 compared with 34.1% in 2013 (Figure LI 36). In 2023, 69.8% of liver transplant recipients were White, 17.5% Hispanic, 6.6% Black, 4.1% Asian, 0.6% Multiracial, and 0.4% unreported (Figure LI 37). With the decline in hepatitis C and the rise in alcohol-associated liver disease and MASH, the age composition of the waiting list has also shifted, with a higher proportion of recipients aged 35-49 years (23.3% in 2023 versus 16.5% in 2013) and 65 years or older (22.4% versus 16.3%), and fewer aged 50-64 years (46.8% versus 61.6%) (Table LI 6). There were more recipients in the highest BMI categories: BMI of 35 kg/m² or greater, 15.5% in 2023 versus 13.0% in 2013; BMI of 30-<35 kg/m², 22.4% in 2023 versus 21.5% in 2013. Only 3.4% of recipients had a history of previous transplant in 2023, compared with 5.0% in 2013 (Figure LI 40 and Table LI 8).

Most adult liver transplants were covered by private insurance (50.9%), followed by Medicare (26.0%) and Medicaid (19.0%). Based on the rural-urban commuting area designation of their home zip code, 82.8% of recipients lived in metropolitan areas; 56.7% lived less than 50 miles from the transplant center, 17.6% within 50-<100 miles, 9.2% within 100-<150 miles, 7.8% within 150-<250 miles, and 7.9% 250 miles or farther (Table LI 6).

Recipients of livers procured from DCD made up 16.7% of adult liver transplants in 2023, a marked increase from preceding years (11.3% in 2022 and 5.2% in 2013), likely related to the wider availability of machine perfusion technologies (Figure LI 39). Only 91 adults received split deceased donor livers (0.9% of adult transplants in 2023 versus 1.2% in 2013) (Table LI 8).

In 2023, there were 804 adult recipients of SLK transplants, representing 7.9% of total liver transplants, a decrease from 9.6% in 2017 when standardized medical eligibility criteria were introduced (Figure LI 41). By far, patients who received SLK transplant were listed via the chronic kidney disease criteria (89.7%) rather than acute kidney injury (9.5%) or metabolic disease (0.2%) criteria (Figure LI 42).

Regarding immunosuppression, induction therapy was used in 30.3% of adult liver transplants, most often with interleukin-2 receptor antibody alone (24.6%) rather than T-cell–depleting agent alone (5.6%) (Figure LI 46 and Figure LI 47). Most liver transplant recipients were maintained on a combination of tacrolimus, a mycophenolate agent, and steroids (66.6%); the remainder used tacrolimus and mycophenolate (18.7%), tacrolimus and steroids (4.4%), or another regimen (10.3%) (Figure LI 48).

2.4 Outcomes

Graft failure was reported in 6.3% at 6 months and 7.9% at 1 year for adult deceased donor liver transplant recipients in 2022, 15.8% at 3 years for those who received transplant in 2020, 20.7% at 5 years for those who received transplant in 2018, and 36.7% at 10 years for those who received transplant in 2013 (Figure LI 49). Overall patient outcomes followed a similar pattern, with mortality of 5.0% at 6 months, 6.5% at 1 year, 14.0% at 3 years, 19.0% at 5 years, and 34.6% at 10 years (Figure LI 51). Over the past decade, 1-year graft failure and patient mortality have decreased; these values were 7.9% and 6.5%, respectively, for patients who underwent transplant in 2022, compared with 11.6% and 10.0%, respectively, for patients who underwent transplant in 2012.

Among adult recipients of deceased donor liver transplant in 2016-2018, 5-year graft survival was 75.0% among those aged 65 years or older, 79.3% for those aged 50-64 years, 82.2% for those aged 35-49 years, and 80.8% for those aged 18-34 years. Patient survival followed a similar pattern (Figure LI 52 and Figure LI 68). Lower graft and patient survival were observed in Black or Other race compared with White, Hispanic, or Asian recipients (Figure LI 53 and Figure LI 69); in male recipients compared with female recipients (Figure LI 54 and Figure LI 70); in those with HCC and MASH diagnoses compared with other etiologies (Figure LI 55 and Figure LI 71); and in those with MELD scores of 40 or greater compared with other MELD categories (39 or lower) (Figure LI 56 and Figure LI 72). In all of these groups, however, 5-year graft survival still exceeded 74.1% and patient survival exceeded 75.1%. The 5-year graft survival rate for DCD livers was 75.6%, compared with 79.2% for recipients of donation after brain death (DBD) livers (Figure LI 57). Liver transplant recipients with HCC MELD exception had a 5-year graft survival rate of 77.6% compared with 79.3% in those without (Figure LI 58).

Graft outcomes among adult living donor liver transplant recipients were: 5.8% graft failure at 6 months, 6.6% at 1 year, 13.6% at 3 years, 21.2% at 5 years, and 40.8% at 10 years (Figure LI 50). The 5-year graft survival among living donor liver transplant recipients was highest for cholestatic liver disease (85.8%) and MASH (83.9%) compared with other etiologies (Figure LI 63). Older recipients (aged 65 years or older) had worse outcomes, with 5-year patient survival of 76.6%, compared with 82.5%, 88.4%, and 94.2% for ages 50-64 years, 35-49 years, and 18-34 years, respectively (Figure LI 73).

Among liver recipients who underwent transplant in 2022, the incidence of reported acute rejection by 1-year posttransplant was higher among younger adult patients (20.2% for age 18-34 years) and lower among older patients (7.9% for age 65 years or older) (Figure LI 65). Among adult liver transplant recipients in 2012-2018, the 5-year incidence of reported posttransplant lymphoproliferative disorder was 1.0% in those with positive Epstein-Barr virus (EBV) status at transplant and 2.0% in those with negative EBV status at transplant (Figure LI 67).

In 2023, there were 734 new adult registrations for kidney transplant with a previous history of liver transplant (Figure LI 43). The most common primary diagnosis for kidney transplant waitlisting among liver transplant recipients was hepatorenal syndrome (31.1%), followed by Other/unknown (20.2%), diabetes (17.7%), and calcineurin nephrotoxicity (16.6%) (Figure LI 44). Hepatorenal syndrome as the primary diagnosis for kidney transplant increased notably after implementation of the SLK eligibility criteria, as did safety net listings (i.e., waitlisting 60-<365 days after liver transplant), which accounted for 327 (44.6%) new registrations (Figure LI 43). There were 418 kidney transplants in recipients with a previous history of liver transplant, which increased from 274 since implementation of the safety net policy in 2017 (Figure LI 45).

3 Donation

In 2023, there were 10,967 deceased donors whose livers were recovered for transplant in the United States, another record high (Figure LI 77). This was driven by an increase in older donors (40 years or older), whereas the number of younger donors (pediatric [younger than 18 years] and adults aged 18-29 years) remained relatively stable (Figure LI 78). Only 5.8% of donors were younger than 18 years, 17.1% were aged 18-29 years, 20.3% were aged 30-39 years, 29.5% were aged 40-54 years, and 27.3% were aged 55 years or older (Figure LI 80). The sex distribution of donors was similar to that in previous years at 61.3% male and 38.7% female (Figure LI 81), as were racial and ethnic categories: 62.3% White, 18.3% Black, 14.9% Hispanic, 3.0% Asian, and 1.5% Other (Figure LI 82). Although the absolute number of HCV-positive donors by antibody testing increased, the overall proportion decreased, representing 8.8% of deceased liver donors in 2023 (Figure LI 79); by both antibody and nucleic acid test (NAT), 91.1% of donor livers were HCV negative (Ab-/NAT-), 4.7% were HCV positive with Ab+ and NAT-, and 4.1% were HCV positive with NAT+ (Figure LI 83). The most common cause of death among liver donors remained anoxia (49.0%), followed by cerebrovascular accident/stroke (24.4%), head trauma (23.8%), and Other/unknown (2.7%) (Figure LI 86).

In recent years, the proportion of DCD livers recovered for transplant has increased markedly, representing 20.1% of deceased donor livers in 2023, an increase from 14.1% in 2022, 9.0% in 2018, and 6.3% in 2013 (Figure LI 84); this increase reflects the promise of machine perfusion technologies to reduce the risk of ischemic injury and improve organ viability. There are also more donor livers undergoing liver biopsy (46.9%): 37.1% reported <11% macrovesicular steatosis, 7.0% had 11%-<31%, and 2.8% had 31% or greater (Figure LI 85).

The overall nonuse rate, or percent of livers recovered for transplant and not transplanted, was 9.7% in 2023, a slight decrease from the preceding years (Figure LI 87). Livers from older donors were less likely to be used (12.4% for donors aged 55 years or older versus 3.2% for donors younger than 18 years) (Figure LI 88). Livers from HCV NAT+ donors were more likely to be recovered and not transplanted (14.6%), while livers from HCV Ab+/NAT- donors were used at similar rates as those from HCV Ab-/NAT- donors (9.2% and 9.5%, respectively) (Figure LI 92). Livers with risk factors present by US Public Health Service criteria were not less likely to be used than those without this designation (Figure LI 93). DCD livers remained over three times more likely than DBD livers to be unused in 2023, although the nonuse rate for both DCD and DBD livers has decreased compared with years prior (22.8% in 2023 versus 30.0% in 2019 for DCD; 6.5% in 2023 versus 7.1% in 2019 for DBD) (Figure LI 94). Livers with macrovesicular steatosis were also more likely to be unused (48.7% for livers with 31% fat or greater, 18.2% for livers with 11%-<31% fat, and 10.1% for livers with <11% fat versus 6.4% for livers without liver biopsy values reported) (Figure LI 95).

There were 659 living donors in 2023, an all-time high—driven by an increase in directed (26.3%) or Other donor-relation donors (15.2%), while the number of donor livers from related persons or spouses/partners remained stable (Figure LI 96). A small but growing number of living donor liver transplants (49 [7.5%]) were performed as a paired donation. Living donors were somewhat older than in previous years, with 7.3% aged 55 years or older, 35.8% aged 40-54 years, 36.7% aged 30-39 years, 20.0% aged 18-29 years, and 0.2% younger than 18 years (Figure LI 97). Living donors were more likely to be female than male (59.2% versus 40.8%) and more likely to be White than all other races and ethnicities combined (76.8% versus 23.2%) (Figure LI 98 and Figure LI 99).

Living donors most often donated the right lobe (80.7%), an increasing trend; 1.1% of living liver donations were recorded as whole domino (Figure LI 100).

4 Pediatric Liver Transplant

4.1 Waiting List

In 2023, there were 1,142 pediatric liver candidates listed at any time during the year in the United States, with 438 on the list at the start of the year and 704 candidates newly added (Figure LI 102, Figure LI 103, and Table LI 12). Over the course of the year, 738 patients were removed (63.7% for deceased donor liver transplant, 10.7% for living donor liver transplant, 3.7% for death, 1.8% for being too sick, 13.0% for improved condition, and 7.2% for a reason of Other), leaving 404 candidates still waiting, an 8% decrease from 2022 (Table LI 12 and Table LI 13).

Among pediatric candidates, the largest age category was 1-5 years (35.3%), followed by 12-17 years (21.3%) and younger than 1 year (18.4%) (Figure LI 104). Compared with 10 years ago, there were more liver transplant candidates in the younger age groups and fewer adolescents (12 years or older). In terms of race and ethnicity, most candidates were White (45.9%), followed by Hispanic (24.8%), Black (17.5%), Asian (6.0%), Multiracial (4.1%), Native American (1.1%), and unreported (0.7%) (Figure LI 105).

Among pediatric candidates who had been listed in 2018-2020, 66.9% received deceased donor liver transplant, 9.8% received living donor liver transplant, 3.2% died, 16.0% were removed from the list, and 4.1% were still waiting (Figure LI 107).

Overall deceased donor liver transplant rates for pediatric candidates remained stable in 2023 at 110.9 transplants per 100 patient-years, which had increased slightly after the allocation policy change in 2020 that prioritized pediatric donors for pediatric recipients (Figure LI 108). Deceased donor liver transplant rates were higher for age younger than 1 year compared with other pediatric age categories (Figure LI 109) and for the White, Black, and Other racial and ethnic categories compared with the Hispanic and Asian categories (Figure LI 110).

The overall pretransplant mortality rate for pediatric candidates in 2023 was 6.7 deaths per 100 patient-years, which has increased from a nadir of 4.9 deaths per 100 patients-years in 2020 (Figure LI 111). Despite the higher deceased donor liver transplant rate, the highest pretransplant mortality was still among the age category of younger than 1 year (18.6 deaths per 100 patient-years; Figure LI 112) and among the Black and Other racial and ethnic categories compared with Hispanic, White, and Asian (Figure LI 113).

4.2 Transplants

In 2023, there were 534 pediatric liver transplants, including retransplant and multiorgan recipients, a relatively stable number compared with previous years (Figure LI 114). The proportion of living donation has increased, to 14.6% in 2023 from 7.7% in 2013 (Figure LI 115).

Among all pediatric liver transplant recipients, 24.9% were aged younger than 1 year, 37.6% were aged 1-5 years, 16.9% were aged 6-11 years, and 20.6% were aged 12-17 years (Figure LI 116 and Table LI 14). The most common diagnosis among these liver transplant recipients was biliary atresia (37.5%), followed by Other/unknown etiologies (24.3%), metabolic disease (14.8%), hepatoblastoma (8.1%), acute liver failure (8.1%), and other cholestatic disease (7.3%) (Table LI 15). Similar to adult liver transplant, the proportion of pediatric recipients with a history of prior transplant decreased: 4.5% in 2023 compared with 8.8% in 2013 (Table LI 16).

In terms of medical urgency, 9.7% of pediatric liver transplant recipients underwent transplant as status 1A; 22.3%, as status 1B; 1.7%, with MELD or PELD score of 40 or greater; 1.1%, with MELD/PELD of 35-39; 6.7%, with MELD/PELD of 25-34; 16.9%, with MELD/PELD of 15-24; and 41.2%, with MELD/PELD of 14 or lower (Table LI 15). In July 2023, criteria for status 1B qualification were updated, along with PELD updating to PELD-creatinine, but this has not yet resulted in any detectable changes in the medical urgency status. Among pediatric liver transplant recipients in 2023, 65.4% had waited fewer than 90 days, 16.7% waited for 3-<6 months, 10.5% waited for 6-<12 months, 5.1% waited for 1-<2 years, and 2.4% waited for 2 or more years (Table LI 16). Overall, waiting times were shorter than in 2013. The proportion of ABO-incompatible pediatric transplants increased: 4.3% in 2023 compared with 3.6% in 2013. No pediatric patients received a liver from a DCD donor in 2023. Most received whole liver (58.4%), followed by partial liver (21.7%) and split liver (19.9%), which represents a modest increase in split liver acceptance since 2021 (Figure LI 117).

The most common insurance among pediatric liver transplant recipients in 2023 was Medicaid (50.7%), followed by private insurance (37.8%). Based on the recipient’s reported zip code, 82.5% lived in metropolitan areas; 45.1% lived less than 50 miles from the transplant center, 16.7% within 50-<100 miles, 12.2% within 100-<150 miles, 11.4% within 150-<250 miles, and 12.9% were 250 miles or farther (Table LI 14).

Induction agent use was reported in 40.4% of pediatric liver transplant recipients in 2023 (Figure LI 118), more commonly interleukin-2 receptor antibody than T-cell depleting agent (Figure LI 119). The most common immunosuppression regimens were combination tacrolimus, mycophenolate, and steroids (39.0%) or combination tacrolimus and steroids (36.9%) (Figure LI 120).

4.3 Outcomes

Short-term graft failure rates among pediatric deceased donor liver transplant recipients increased in 2022 (9.1% at 6 months and 10.7% at 1 year) compared with previous years (Figure LI 121). Longer-term graft failure rates were similar: 10.6% at 3 years for transplants in 2020, 12.2% at 5 years for transplants in 2018, and 23.1% at 10 years for transplants in 2013. Mirroring the graft outcomes, short-term patient mortality worsened (7.6% at 6 months, 8.9% at 1 year, and 9.8% at 3 years) compared with previous years (Figure LI 129). Longer-term outcomes were stable or improved, with a patient mortality rate of 7.6% at 5 years for transplants in 2018 and 13.9% at 10 years for transplants in 2013.

Among pediatric deceased donor liver transplant recipients in 2016-2018, overall 5-year graft survival was 86.3% and patient survival was 90.3% (Figure LI 126, Figure LI 130, and Figure LI 133). Five-year graft survival was highest among those with metabolic disease (95.5%), biliary atresia (90.9%), or other cholestatic disease (87.6%) and was lowest among those with a diagnosis of hepatoblastoma (78.8%) or Other/unknown etiology (75.0%) (Figure LI 124).

Outcomes among pediatric living donor liver transplant recipients were superior to those among deceased donor recipients, with graft failure rates of 5.7% at 6 months, 5.7% at 1 year, 7.6% at 3 years, 9.7% at 5 years, and 17.1% at 10 years (Figure LI 122); overall 5-year patient survival was 94.9% (Figure LI 126 and Figure LI 133).

The incidence of acute rejection by 1-year posttransplant for pediatric liver transplant recipients was 19.3% for those younger than 1 year, 25.9% for ages 1-5 years, 22.9% for ages 6-11 years, and 15.6% for ages 12-17 years (Figure LI 127), rates that are higher than those observed in adult recipients. The overall 5-year incidence of posttransplant lymphoproliferative disorder for pediatric recipients who underwent transplant in 2012-2018 was 4.4%: 5.2% among those with EBV-negative status and 3.1% among those with EBV-positive status at the time of transplant (Figure LI 128).

Support, Copyright, and Citation Information

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. Dr. Israni was supported in part by AHRQ R01HS028829.

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Pursuant to 42 U.S.C. 1320b-10, this publication may not be reproduced, reprinted, or redistributed for a fee without specific written authorization from HHS.

Suggested Citations:

Full citation: Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2023 Annual Data Report. U.S. Department of Health and Human Services, Health Resources and Services Administration; 2025. Accessed [insert date]. https://srtr.transplant.hrsa.gov/annualdatareports
Abbreviated full citation: OPTN/SRTR 2023 Annual Data Report. HHS/HRSA; 2025. Accessed [insert date]. https://srtr.transplant.hrsa.gov/annualdatareports
Chapter citation: [Authors]. OPTN/SRTR 2023 Annual Data Report: [chapter]. Accessed [insert date]. https://srtr.transplant.hrsa.gov/annualdatareports
Chapter citation for AJT e-supplement available at amjtransplant.org: [Authors]. OPTN/SRTR 2023 Annual Data Report: [chapter]. Am J Transplant. 2025;25([issue and suppl numbers]):[page range]. [doi]

Publications based on data in this report or supplied on request must include a citation and the following statement: The data and analyses reported in the OPTN/SRTR 2023 Annual Data Report have been supplied by the United Network for Organ Sharing and Hennepin Healthcare Research Institute under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. government.

This report is available at https://srtr.transplant.hrsa.gov/annualdatareports. 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 and ethnicity
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 and ethnicity
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: Three-year outcomes for adults waiting for liver transplant, new listings in 2018-2020
Figure LI 18: Percentage of adults who underwent deceased donor liver transplant within a given period of listing
Figure LI 19: Overall pretransplant mortality rates among adults waitlisted for liver transplant
Figure LI 20: Pretransplant mortality rates among adults waitlisted for liver transplant by age
Figure LI 21: Pretransplant mortality rates among adults waitlisted for liver transplant by race and ethnicity
Figure LI 22: Pretransplant mortality rates among adults waitlisted for liver transplant by sex
Figure LI 23: Pretransplant mortality rates among adults waitlisted for liver transplant by diagnosis
Figure LI 24: Pretransplant mortality rates among adults waitlisted for liver transplant by first laboratory MELD score in the year
Figure LI 25: Pretransplant mortality rates among adults waitlisted for liver by HCC exception status
Figure LI 26: Pretransplant mortality rates among adults waitlisted for liver transplant in 2023 by DSA
Figure LI 27: Deaths within 6 months after removal among adult liver waitlist candidates, overall
Figure LI 28: Deaths within 6 months after removal among adult liver waitlist candidates, by laboratory MELD score at removal
Figure LI 29: Deaths within 6 months after removal among adult liver waitlist candidates, by age
Figure LI 30: Deaths within 6 months after removal among adult liver waitlist candidates, by race and ethnicity
Figure LI 31: Deaths within 6 months after removal among adult liver waitlist candidates, by sex
Figure LI 32: Overall liver transplants
Figure LI 33: Overall adult liver transplants
Figure LI 34: Adult liver transplants by donor type
Figure LI 35: Adult liver transplants by age
Figure LI 36: Adult liver transplants by sex
Figure LI 37: Adult liver transplants by race and ethnicity
Figure LI 38: Adult liver transplants by diagnosis
Figure LI 39: Adult liver transplants by DCD status
Figure LI 40: Adult liver transplants by prior transplant status
Figure LI 41: Adult liver transplants by SLK
Figure LI 42: Adult SLK transplants by SLK diagnosis
Figure LI 43: New adult candidates added to the kidney transplant waiting list after liver transplant by time to kidney listing from liver transplant
Figure LI 44: New adult candidates added to the kidney transplant waiting list after liver transplant by diagnosis
Figure LI 45: Adult kidney transplants by SLK safety net eligibility
Figure LI 46: Induction agent use in adult liver transplant recipients
Figure LI 47: Type of induction agent use in adult liver transplant recipients
Figure LI 48: Immunosuppression regimen use in adult liver transplant recipients
Figure LI 49: Graft failure among adult deceased donor liver transplant recipients
Figure LI 50: Graft failure among adult living donor liver transplant recipients
Figure LI 51: Patient death among adult liver transplant recipients
Figure LI 52: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by age
Figure LI 53: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by race and ethnicity
Figure LI 54: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by sex
Figure LI 55: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by diagnosis
Figure LI 56: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by laboratory MELD score
Figure LI 57: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by DCD status
Figure LI 58: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by HCC status
Figure LI 59: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by BMI
Figure LI 60: Graft survival among adult living donor liver transplant recipients, 2016-2018, by age
Figure LI 61: Graft survival among adult living donor liver transplant recipients, 2016-2018, by race and ethnicity
Figure LI 62: Graft survival among adult living donor liver transplant recipients, 2016-2018, by sex
Figure LI 63: Graft survival among adult living donor liver transplant recipients, 2016-2018, by diagnosis
Figure LI 64: Graft survival among adult living donor liver transplant recipients, 2016-2018, by laboratory MELD score
Figure LI 65: Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by age
Figure LI 66: Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by induction agent
Figure LI 67: Incidence of PTLD among adult liver transplant recipients by recipient EBV status at transplant, 2012-2018
Figure LI 68: Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by age
Figure LI 69: Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by race and ethnicity
Figure LI 70: Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by sex
Figure LI 71: Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by diagnosis
Figure LI 72: Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by laboratory MELD score
Figure LI 73: Patient survival among adult living donor liver transplant recipients, 2016-2018, by age
Figure LI 74: Patient survival among adult living donor liver transplant recipients, 2016-2018, by diagnosis
Figure LI 75: Patient survival among adult living donor liver transplant recipients, 2016-2018, by race and ethnicity
Figure LI 76: Patient survival among adult living donor liver transplant recipients, 2016-2018, by laboratory MELD score
Figure LI 77: Overall deceased liver donor count
Figure LI 78: Deceased liver donor count by age
Figure LI 79: Deceased liver donor count by HCV status
Figure LI 80: Distribution of deceased liver donors by age
Figure LI 81: Distribution of deceased liver donors by sex
Figure LI 82: Distribution of deceased liver donors by race and ethnicity
Figure LI 83: Distribution of deceased liver donors by donor HCV status
Figure LI 84: Distribution of deceased liver donors by DCD status
Figure LI 85: Distribution of deceased liver donors by macrovesicular fat
Figure LI 86: Cause of death among deceased liver donors
Figure LI 87: Overall percent of livers recovered for transplant and not transplanted
Figure LI 88: Percent of livers recovered for transplant and not transplanted by donor age
Figure LI 89: Percent of livers recovered for transplant and not transplanted by donor sex
Figure LI 90: Percent of livers recovered for transplant and not transplanted by donor race and ethnicity
Figure LI 91: Percent of livers recovered for transplant and not transplanted by donor cause of death
Figure LI 92: Percent of livers recovered for transplant and not transplanted by donor HCV status
Figure LI 93: Percent of livers recovered for transplant and not transplanted, by donor risk of disease transmission
Figure LI 94: Percent of livers recovered for transplant and not transplanted by DCD status
Figure LI 95: Percent of livers recovered for transplant and not transplanted by macrovesicular fat
Figure LI 96: Number of living liver donors by donor relation
Figure LI 97: Living liver donors by age
Figure LI 98: Living liver donors by sex
Figure LI 99: Living liver donors by race and ethnicity
Figure LI 100: Living donor liver transplant graft type
Figure LI 101: BMI among living liver donors
Figure LI 102: New pediatric candidates added to the liver transplant waiting list
Figure LI 103: All pediatric candidates on the liver transplant waiting list
Figure LI 104: Distribution of pediatric candidates waiting for liver transplant by age
Figure LI 105: Distribution of pediatric candidates waiting for liver transplant by race and ethnicity
Figure LI 106: Distribution of pediatric candidates waiting for liver transplant by sex
Figure LI 107: Three-year outcomes for newly listed pediatric candidates waiting for liver transplant, 2018-2020
Figure LI 108: Overall deceased donor liver transplant rates among pediatric waitlist candidates
Figure LI 109: Deceased donor liver transplant rates among pediatric waitlist candidates by age
Figure LI 110: Deceased donor liver transplant rates among pediatric waitlist candidates by race and ethnicity
Figure LI 111: Overall pretransplant mortality rates among pediatric candidates waitlisted for liver
Figure LI 112: Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by age
Figure LI 113: Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by race and ethnicity
Figure LI 114: Overall pediatric liver transplants
Figure LI 115: Pediatric liver transplants by donor type
Figure LI 116: Pediatric liver transplants by recipient age
Figure LI 117: Split or partial liver transplants in children
Figure LI 118: Induction agent use in pediatric liver transplant recipients
Figure LI 119: Type of induction agent use in pediatric liver transplant recipients
Figure LI 120: Immunosuppression regimen use in pediatric liver transplant recipients
Figure LI 121: Graft failure among pediatric deceased donor liver transplant recipients
Figure LI 122: Graft failure among pediatric living donor liver transplant recipients
Figure LI 123: Graft survival among pediatric deceased donor liver transplant recipients, 2016-2018, by age
Figure LI 124: Graft survival among pediatric deceased donor liver transplant recipients, 2016-2018, by diagnosis
Figure LI 125: Graft survival among pediatric deceased donor liver transplant recipients, 2016-2018, by laboratory MELD or PELD score
Figure LI 126: Graft survival among pediatric liver transplant recipients, 2016-2018, by donor type
Figure LI 127: Incidence of acute rejection by 1 year posttransplant among pediatric liver transplant recipients by age
Figure LI 128: Incidence of PTLD among pediatric liver transplant recipients by recipient EBV status at transplant, 2012-2018
Figure LI 129: Patient death among pediatric liver transplant recipients
Figure LI 130: Overall patient survival among pediatric deceased donor liver transplant recipients, 2016-2018
Figure LI 131: Patient survival among pediatric deceased donor liver transplant recipients, 2016-2018, by recipient age
Figure LI 132: Patient survival among pediatric deceased donor liver transplant recipients, 2016-2018, by diagnosis
Figure LI 133: Patient survival among pediatric liver transplant recipients, 2016-2018, by donor type

List of Tables

Table LI 1: Demographic characteristics of adults on the liver transplant waiting list on December 31, 2013, and December 31, 2023
Table LI 2: Clinical characteristics of adults on the liver transplant waiting list on December 31, 2013, and December 31, 2023
Table LI 3: Listing characteristics of adults on the liver transplant waiting list on December 31, 2013, and December 31, 2023
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, 2013 and 2023
Table LI 7: Clinical characteristics of adult liver transplant recipients, 2013 and 2023
Table LI 8: Transplant characteristics of adult liver transplant recipients, 2013 and 2023
Table LI 9: Demographic characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2013, and December 31, 2023
Table LI 10: Clinical characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2013, and December 31, 2023
Table LI 11: Listing characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2013, and December 31, 2023
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, 2013 and 2023
Table LI 15: Clinical characteristics of pediatric liver transplant recipients, 2013 and 2023
Table LI 16: Transplant characteristics of pediatric liver transplant recipients, 2013 and 2023

**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 and ethnicity.** 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 and ethnicity. 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; MASH, metabolic dysfunction--associated 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; MASH, metabolic dysfunction–associated 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. MELD, model for end-stage liver disease.

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. MELD, model for end-stage liver disease.

**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. BMI, body mass index.

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. BMI, body mass index.

**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.

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

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 waiting 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 waiting 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 waiting 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 and ethnicity.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure LI 13: Deceased donor liver transplant rates among adult waitlist candidates by race and ethnicity. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

**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 waiting 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 waiting 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 waiting time in a given year. Individual listings are counted separately. HCC is determined at the later of listing date or 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 waiting time in a given year. Individual listings are counted separately. HCC is determined at the later of listing date or 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 waiting 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 waiting time in a given year. Individual listings are counted separately.

**Three-year outcomes for adults waiting for liver transplant, new listings in 2018-2020.** 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 17: Three-year outcomes for adults waiting for liver transplant, new listings in 2018-2020. 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 18: 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 time 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 19: 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 time 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 time 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 20: 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 time 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 and ethnicity.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time 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. The Other race category is composed of Native American and Multiracial categories.

Figure LI 21: Pretransplant mortality rates among adults waitlisted for liver transplant by race and ethnicity. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time 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. The Other race category is composed of Native American and Multiracial categories.

**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 time 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 sex. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time 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 time 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; MASH, metabolic dysfunction--associated steatohepatitis.

Figure LI 23: 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 time 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; MASH, metabolic dysfunction–associated steatohepatitis.

**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 time 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 or January 1 of the year. MELD, model for end-stage liver disease.

Figure LI 24: 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 time 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 or January 1 of the year. MELD, model for end-stage liver disease.

**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 time 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 or January 1 of the year. HCC, hepatocellular carcinoma.

Figure LI 25: 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 time 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 or January 1 of the year. HCC, hepatocellular carcinoma.

**Pretransplant mortality rates among adults waitlisted for liver transplant in 2023 by DSA.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time 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. DSA, donation service area.

Figure LI 26: Pretransplant mortality rates among adults waitlisted for liver transplant in 2023 by DSA. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time 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. DSA, donation service area.

**Deaths within 6 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 27: Deaths within 6 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 6 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. MELD, model for end-stage liver disease.

Figure LI 28: Deaths within 6 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. MELD, model for end-stage liver disease.

**Deaths within 6 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 29: Deaths within 6 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.

**Deaths within 6 months after removal among adult liver waitlist candidates, by race and ethnicity.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The Other race category is composed of Native American and Multiracial categories.

Figure LI 30: Deaths within 6 months after removal among adult liver waitlist candidates, by race and ethnicity. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The Other race category is composed of Native American and Multiracial categories.

**Deaths within 6 months after removal among adult liver waitlist candidates, by sex.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure LI 31: Deaths within 6 months after removal among adult liver waitlist candidates, by sex. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

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

Figure LI 32: Overall liver transplants. All liver transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure LI 33: Overall adult liver transplants. All adult liver transplant recipients, including retransplant and multiorgan recipients.

Figure LI 34: Adult liver transplants by donor type. Adult liver transplant recipients, including retransplant and multiorgan recipients.

Figure LI 35: Adult liver transplants by age. Adult liver transplant recipients, including retransplant and multiorgan recipients.

Figure LI 36: Adult liver transplants by sex. Adult liver transplant recipients, including retransplant and multiorgan recipients.

$**Adult liver transplants by race and ethnicity.** Adult liver transplant recipients, including retransplant and multiorgan recipients.$

Figure LI 37: Adult liver transplants by race and ethnicity. Adult liver transplant recipients, including retransplant and multiorgan recipients.

**Adult liver transplants by diagnosis.** Adult liver transplant recipients, including retransplant and multiorgan recipients. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; MASH, metabolic dysfunction--associated steatohepatitis.

Figure LI 38: Adult liver transplants by diagnosis. Adult liver transplant recipients, including retransplant and multiorgan recipients. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; MASH, metabolic dysfunction–associated steatohepatitis.

**Adult liver transplants by DCD status.** Adult liver transplant recipients, including retransplant and multiorgan recipients. DBD, donation after brain death; DCD, donation after circulatory death.

Figure LI 39: Adult liver transplants by DCD status. Adult liver transplant recipients, including retransplant and multiorgan recipients. DBD, donation after brain death; DCD, donation after circulatory death.

**Adult liver transplants by prior transplant status.** Adult liver transplant recipients, including retransplant and multiorgan recipients.

Figure LI 40: Adult liver transplants by prior transplant status. Adult liver transplant recipients, including retransplant and multiorgan recipients.

**Adult liver transplants by SLK.** Adult liver transplant recipients, including retransplant and multiorgan recipients. SLK transplants are in recipients with a liver and kidney transplant from the same donor. SLK, simultaneous liver-kidney.

Figure LI 41: Adult liver transplants by SLK. Adult liver transplant recipients, including retransplant and multiorgan recipients. SLK transplants are in recipients with a liver and kidney transplant from the same donor. SLK, simultaneous liver-kidney.

**Adult SLK transplants by SLK diagnosis.** Adult SLK transplant recipients, including retransplant and multiorgan recipients. SLK transplants are in recipients with a liver and kidney transplant from the same donor. SLK, simultaneous liver-kidney.

Figure LI 42: Adult SLK transplants by SLK diagnosis. Adult SLK transplant recipients, including retransplant and multiorgan recipients. SLK transplants are in recipients with a liver and kidney transplant from the same donor. SLK, simultaneous liver-kidney.

**New adult candidates added to the kidney transplant waiting list after liver transplant by time to kidney listing from liver transplant.** 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 43: New adult candidates added to the kidney transplant waiting list after liver transplant by time to kidney listing from liver transplant. 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.

**New adult candidates added to the kidney transplant waiting list after liver transplant by diagnosis.** 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. CNI, calcineurin inhibitor.

Figure LI 44: New adult candidates added to the kidney transplant waiting list after liver transplant by diagnosis. 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. CNI, calcineurin inhibitor.

**Adult kidney transplants by SLK safety net eligibility.** Adult kidney transplant recipients, including retransplant and multiorgan recipients. SLK transplants are in recipients with a liver and kidney transplant from the same donor. SLK, simultaneous liver-kidney; SN, safety net.

Figure LI 45: Adult kidney transplants by SLK safety net eligibility. Adult kidney transplant recipients, including retransplant and multiorgan recipients. SLK transplants are in recipients with a liver and kidney transplant from the same donor. SLK, simultaneous liver-kidney; SN, safety net.

Figure LI 46: Induction agent use in adult liver transplant recipients. Immunosuppression at transplant reported to the OPTN.

**Type of induction agent use in adult liver transplant recipients.** Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure LI 47: Type of induction agent use in adult liver transplant recipients. Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

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

Figure LI 48: Immunosuppression regimen use in adult liver transplant recipients. Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

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

Figure LI 49: Graft failure among adult deceased donor liver transplant recipients. All adult recipients of deceased donor livers, including multiorgan transplant recipients.

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

Figure LI 50: Graft failure among adult living donor liver transplant recipients. All adult recipients of living donor livers, including multiorgan transplant recipients.

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

Figure LI 51: Patient death among adult liver transplant recipients. All adult recipients of deceased donor livers, including multiorgan transplant recipients.

**Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by age.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 52: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by age. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by race and ethnicity.** Graft survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

Figure LI 53: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by race and ethnicity. Graft survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

**Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by sex.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 54: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by sex. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by diagnosis.** Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; MASH, metabolic dysfunction--associated steatohepatitis.

Figure LI 55: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by diagnosis. Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; MASH, metabolic dysfunction–associated steatohepatitis.

**Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by laboratory MELD score.** Graft survival estimated using unadjusted Kaplan-Meier methods. MELD, model for end-stage liver disease.

Figure LI 56: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by laboratory MELD score. Graft survival estimated using unadjusted Kaplan-Meier methods. MELD, model for end-stage liver disease.

**Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by DCD status.** Graft survival estimated using unadjusted Kaplan-Meier methods. DBD, donation after brain death; DCD, donation after circulatory death.

Figure LI 57: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by DCD status. Graft survival estimated using unadjusted Kaplan-Meier methods. DBD, donation after brain death; DCD, donation after circulatory death.

**Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by HCC status.** Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma.

Figure LI 58: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by HCC status. Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma.

**Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by BMI.** Graft survival estimated using unadjusted Kaplan-Meier methods. BMI, body mass index.

Figure LI 59: Graft survival among adult deceased donor liver transplant recipients, 2016-2018, by BMI. Graft survival estimated using unadjusted Kaplan-Meier methods. BMI, body mass index.

**Graft survival among adult living donor liver transplant recipients, 2016-2018, by age.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 60: Graft survival among adult living donor liver transplant recipients, 2016-2018, by age. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among adult living donor liver transplant recipients, 2016-2018, by race and ethnicity.** Graft survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

Figure LI 61: Graft survival among adult living donor liver transplant recipients, 2016-2018, by race and ethnicity. Graft survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

**Graft survival among adult living donor liver transplant recipients, 2016-2018, by sex.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 62: Graft survival among adult living donor liver transplant recipients, 2016-2018, by sex. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among adult living donor liver transplant recipients, 2016-2018, by diagnosis.** Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; MASH, metabolic dysfunction--associated steatohepatitis.

Figure LI 63: Graft survival among adult living donor liver transplant recipients, 2016-2018, by diagnosis. Graft survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; MASH, metabolic dysfunction–associated steatohepatitis.

**Graft survival among adult living donor liver transplant recipients, 2016-2018, by laboratory MELD score.** Graft survival estimated using unadjusted Kaplan-Meier methods. MELD, model for end-stage liver disease.

Figure LI 64: Graft survival among adult living donor liver transplant recipients, 2016-2018, by laboratory MELD score. Graft survival estimated using unadjusted Kaplan-Meier methods. MELD, model for end-stage liver disease.

**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 65: 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 66: 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, 2012-2018.** Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Figure LI 67: Incidence of PTLD among adult liver transplant recipients by recipient EBV status at transplant, 2012-2018. Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

**Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by age.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 68: Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by age. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by race and ethnicity.** Patient survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

Figure LI 69: Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by race and ethnicity. Patient survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

**Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by sex.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 70: Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by sex. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by diagnosis.** Patient survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; MASH, metabolic dysfunction--associated steatohepatitis.

Figure LI 71: Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by diagnosis. Patient survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; MASH, metabolic dysfunction–associated steatohepatitis.

**Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by laboratory MELD score.** Patient survival estimated using unadjusted Kaplan-Meier methods. MELD, model for end-stage liver disease.

Figure LI 72: Patient survival among adult deceased donor liver transplant recipients, 2016-2018, by laboratory MELD score. Patient survival estimated using unadjusted Kaplan-Meier methods. MELD, model for end-stage liver disease.

**Patient survival among adult living donor liver transplant recipients, 2016-2018, by age.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 73: Patient survival among adult living donor liver transplant recipients, 2016-2018, by age. Patient survival estimated using unadjusted Kaplan-Meier methods.

$**Patient survival among adult living donor liver transplant recipients, 2016-2018, by diagnosis.** Patient survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; MASH, metabolic dysfunction--associated steatohepatitis.$

Figure LI 74: Patient survival among adult living donor liver transplant recipients, 2016-2018, by diagnosis. Patient survival estimated using unadjusted Kaplan-Meier methods. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; MASH, metabolic dysfunction–associated steatohepatitis.

**Patient survival among adult living donor liver transplant recipients, 2016-2018, by race and ethnicity.** Patient survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

Figure LI 75: Patient survival among adult living donor liver transplant recipients, 2016-2018, by race and ethnicity. Patient survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

**Patient survival among adult living donor liver transplant recipients, 2016-2018, by laboratory MELD score.** Patient survival estimated using unadjusted Kaplan-Meier methods. MELD, model for end-stage liver disease.

Figure LI 76: Patient survival among adult living donor liver transplant recipients, 2016-2018, by laboratory MELD score. Patient survival estimated using unadjusted Kaplan-Meier methods. MELD, model for end-stage liver disease.

Figure LI 77: Overall deceased liver donor count. Count of deceased donors whose livers were recovered for transplant.

Figure LI 78: 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 79: 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 80: Distribution of deceased liver donors by age. Deceased donors whose livers were recovered for transplant.

Figure LI 81: Distribution of deceased liver donors by sex. Deceased donors whose livers were recovered for transplant.

**Distribution of deceased liver donors by race and ethnicity.** Deceased donors whose livers were recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

Figure LI 82: Distribution of deceased liver donors by race and ethnicity. Deceased donors whose livers were recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

**Distribution of deceased liver donors by donor HCV status.** Deceased donors whose livers were recovered for transplant. Donor HCV status was based on NAT and antibody tests. Ab, antibody; HCV, hepatitis C virus; NAT, nucleic acid test.

Figure LI 83: Distribution of deceased liver donors by donor HCV status. Deceased donors whose livers were recovered for transplant. Donor HCV status was based on NAT and antibody tests. Ab, antibody; HCV, hepatitis C virus; NAT, nucleic acid test.

**Distribution of deceased liver donors by DCD status.** Deceased donors whose livers were recovered for transplant. DBD, donation after brain death; DCD, donation after circulatory death.

Figure LI 84: Distribution of deceased liver donors by DCD status. Deceased donors whose livers were recovered for transplant. DBD, donation after brain death; DCD, donation after circulatory death.

Figure LI 85: Distribution of deceased liver donors by macrovesicular fat. Deceased donors whose livers were recovered for transplant.

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

Figure LI 86: Cause of death among deceased liver donors. Deceased donors with a liver recovered for the purposes of transplant. CVA, cerebrovascular accident.

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

Figure LI 87: 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 88: 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 89: 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 and ethnicity.** Percentages of livers not transplanted out of all livers recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

Figure LI 90: Percent of livers recovered for transplant and not transplanted by donor race and ethnicity. Percentages of livers not transplanted out of all livers recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

**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 91: 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.

$**Percent of livers recovered for transplant and not transplanted by donor HCV status.** Percentages of livers not transplanted out of all livers recovered for transplant. Donor HCV status was based on NAT and antibody tests. Ab, antibody; HCV, hepatitis C virus; NAT, nucleic acid test.$

Figure LI 92: 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 NAT and antibody tests. Ab, antibody; HCV, hepatitis C virus; NAT, nucleic acid test.

**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. "Risk factors" refers to risk criteria for acute transmission of human immunodeficiency virus, hepatitis B virus, or hepatitis C virus from the US Public Health Service Guideline.

Figure LI 93: 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. “Risk factors” refers to risk criteria for acute transmission of human immunodeficiency virus, hepatitis B virus, or hepatitis C virus from the US Public Health Service Guideline.

**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 94: 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.

**Percent of livers recovered for transplant and not transplanted by macrovesicular fat.** Percentages of livers not transplanted out of all livers recovered for transplant.

Figure LI 95: Percent of livers recovered for transplant and not transplanted by macrovesicular fat. Percentages of livers not transplanted out of all livers recovered for transplant.

**Number of living liver donors by donor relation.** Numbers of living donor donations, excluding domino livers, as reported on the OPTN Living Donor Registration Form.

Figure LI 96: Number of living liver donors by donor relation. Numbers of living donor donations, excluding domino livers, as reported on the OPTN Living Donor Registration Form.

Figure LI 97: Living liver donors by age. As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.

Figure LI 98: Living liver donors by sex. As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded.

**Living liver donors by race and ethnicity.** As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded. The Other race category is composed of Native American and Multiracial categories.

Figure LI 99: Living liver donors by race and ethnicity. As reported on the OPTN Living Donor Registration Form. Domino liver donors excluded. The Other race category is composed of Native American and Multiracial categories.

Figure LI 100: 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. BMI, body mass index.

Figure LI 101: BMI among living liver donors. Donor height and weight reported on the OPTN Living Donor Registration Form. Domino liver donors excluded. BMI, body mass index.

**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 were subsequently relisted are considered new. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LI 102: New pediatric candidates added to the liver transplant waiting list. A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and were 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 103: All pediatric candidates on the liver transplant waiting list. Pediatric candidates listed at any time during the year. Candidates listed at more than one center are counted once per listing.

**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. The 18+ category is for candidates who turned age 18 while waiting.

Figure LI 104: Distribution of pediatric candidates waiting for liver transplant by age. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year. The 18+ category is for candidates who turned age 18 while waiting.

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

Figure LI 105: Distribution of pediatric candidates waiting for liver transplant by race and ethnicity. 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 106: Distribution of pediatric candidates waiting for liver transplant by sex. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**Three-year outcomes for newly listed pediatric candidates waiting for liver transplant, 2018-2020.** Pediatric candidates who joined the waiting list in 2018-2020. Candidates listed at more than one center are counted once per listing. DD, deceased donor; LD, living donor.

Figure LI 107: Three-year outcomes for newly listed pediatric candidates waiting for liver transplant, 2018-2020. Pediatric candidates who joined the waiting list in 2018-2020. 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 time in a given year. Individual listings are counted separately.

Figure LI 108: Overall deceased donor liver transplant rates among pediatric waitlist candidates. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time 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 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. The 18+ category is for candidates who turned age 18 while waiting.

Figure LI 109: Deceased donor liver transplant rates among pediatric waitlist candidates by age. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting 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. The 18+ category is for candidates who turned age 18 while waiting.

**Deceased donor liver transplant rates among pediatric waitlist candidates by race and ethnicity.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure LI 110: Deceased donor liver transplant rates among pediatric waitlist candidates by race and ethnicity. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

**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 time 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 111: 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 time 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 time 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. The 18+ category is for candidates who turned age 18 while waiting.

Figure LI 112: 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 time 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. The 18+ category is for candidates who turned age 18 while waiting.

**Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by race and ethnicity.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time 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. The Other race category is composed of Native American and Multiracial categories.

Figure LI 113: Pretransplant mortality rates among pediatric candidates waitlisted for liver transplant by race and ethnicity. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time 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. The Other race category is composed of Native American and Multiracial categories.

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

Figure LI 114: 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 115: 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 116: Pediatric liver transplants by recipient age. All pediatric liver transplant recipients, including retransplant and multiorgan recipients.

Figure LI 117: Split or partial liver transplants in children. Percent of transplants from a split liver.

Figure LI 118: Induction agent use in pediatric liver transplant recipients. Immunosuppression at transplant reported to the OPTN.

**Type of induction agent use in pediatric liver transplant recipients.** Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure LI 119: Type of induction agent use in pediatric liver transplant recipients. Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

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

Figure LI 120: Immunosuppression regimen use in pediatric liver transplant recipients. Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

**Graft failure among pediatric deceased donor liver transplant recipients.** All pediatric recipients of deceased donor livers, including multiorgan transplant recipients. 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 121: Graft failure among pediatric deceased donor liver transplant recipients. All pediatric recipients of deceased donor livers, including multiorgan transplant recipients. 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 transplant recipients. 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 122: Graft failure among pediatric living donor liver transplant recipients. All pediatric recipients of living donor livers, including multiorgan transplant recipients. 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, 2016-2018, by age.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 123: Graft survival among pediatric deceased donor liver transplant recipients, 2016-2018, by age. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among pediatric deceased donor liver transplant recipients, 2016-2018, by diagnosis.** Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 124: Graft survival among pediatric deceased donor liver transplant recipients, 2016-2018, by diagnosis. Graft survival estimated using unadjusted Kaplan-Meier methods.

**Graft survival among pediatric deceased donor liver transplant recipients, 2016-2018, by laboratory MELD or PELD score.** Graft survival estimated using unadjusted Kaplan-Meier methods. Pediatric candidates aged 12-17 years can be assigned MELD or PELD scores. MELD, model for end-stage liver disease; PELD, pediatric end-stage liver disease.

Figure LI 125: Graft survival among pediatric deceased donor liver transplant recipients, 2016-2018, by laboratory MELD or PELD score. Graft survival estimated using unadjusted Kaplan-Meier methods. Pediatric candidates aged 12-17 years can be assigned MELD or PELD scores. MELD, model for end-stage liver disease; PELD, pediatric end-stage liver disease.

**Graft survival among pediatric liver transplant recipients, 2016-2018, by donor type.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 126: Graft survival among pediatric liver transplant recipients, 2016-2018, 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 127: 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, 2012-2018.** Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Figure LI 128: Incidence of PTLD among pediatric liver transplant recipients by recipient EBV status at transplant, 2012-2018. Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

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

Figure LI 129: Patient death among pediatric liver transplant recipients. All pediatric recipients of deceased donor livers, including multiorgan transplant recipients. Estimates are unadjusted, computed using Kaplan-Meier methods.

**Overall patient survival among pediatric deceased donor liver transplant recipients, 2016-2018.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 130: Overall patient survival among pediatric deceased donor liver transplant recipients, 2016-2018. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among pediatric deceased donor liver transplant recipients, 2016-2018, by recipient age.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 131: Patient survival among pediatric deceased donor liver transplant recipients, 2016-2018, by recipient age. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among pediatric deceased donor liver transplant recipients, 2016-2018, by diagnosis.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 132: Patient survival among pediatric deceased donor liver transplant recipients, 2016-2018, by diagnosis. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among pediatric liver transplant recipients, 2016-2018, by donor type.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure LI 133: Patient survival among pediatric liver transplant recipients, 2016-2018, by donor type. Recipient survival estimated using unadjusted Kaplan-Meier methods.

Characteristic	2013 N	2013 Percent	2023 N	2023 Percent
Age (years)
18-34 years	681	4.3	542	5.6
35-49	2,286	14.5	1,763	18.1
50-64	9,821	62.3	4,649	47.7
65+	2,973	18.9	2,791	28.6
Sex
Female	5,885	37.3	3,878	39.8
Male	9,876	62.7	5,867	60.2
Race and ethnicity
Asian	797	5.1	482	4.9
Black	1,114	7.1	670	6.9
Hispanic	2,619	16.6	2,004	20.6
Multiracial	44	0.3	56	0.6
Native American	111	0.7	117	1.2
White	11,076	70.3	6,381	65.5
Unreported	0	0	35	0.4
Geography
Metropolitan	13,253	84.1	8,163	83.8
Nonmetropolitan	2,349	14.9	1,459	15.0
Missing	159	1.0	123	1.3
Miles between candidate and center
<50 miles	9,133	57.9	5,480	56.2
50-<100	2,564	16.3	1,821	18.7
100-<150	1,358	8.6	903	9.3
150-<250	1,309	8.3	757	7.8
250+	1,272	8.1	693	7.1
Missing	125	0.8	91	0.9
All candidates
All candidates	15,761	100.0	9,745	100.0
OPTN/SRTR 2023 Annual Data Report

Characteristic	2013 N	2013 Percent	2023 N	2023 Percent
Diagnosis
Acute liver failure	273	1.7	105	1.1
HCV	4,668	29.6	746	7.7
Alcohol-associated cirrhosis	3,725	23.6	3,290	33.8
Alcohol-associated hepatitis	19	0.1	201	2.1
Cholestatic disease	1,360	8.6	785	8.1
HCC	1,059	6.7	1,068	11.0
MASH	1,489	9.4	2,067	21.2
Other/unknown	3,168	20.1	1,483	15.2
Blood type
A	6,106	38.7	3,855	39.6
AB	403	2.6	158	1.6
B	1,698	10.8	872	8.9
O	7,554	47.9	4,860	49.9
Urgency status
14 or lower	7,259	46.1	3,961	40.6
15-24	4,305	27.3	3,228	33.1
25-34	1,378	8.7	232	2.4
35-39	37	0.2	21	0.2
40+	14	0.1	7	0.1
Status 1A	2	0.0	2	0.0
Inactive	2,759	17.5	2,294	23.5
Missing	7	0.0	0	0
HCC status for liver candidates
No HCC exception	14,165	89.9	8,193	84.1
HCC exception	1,589	10.1	1,552	15.9
Missing	7	0.0	0	0
All candidates
All candidates	15,761	100.0	9,745	100.0
OPTN/SRTR 2023 Annual Data Report

Characteristic	2013 N	2013 Percent	2023 N	2023 Percent
Previous transplant
No prior transplant	15,348	97.4	9,476	97.2
Prior transplant	413	2.6	269	2.8
Waiting time
<90 days	2,100	13.3	2,077	21.3
3-<6 months	1,717	10.9	1,428	14.7
6-<12 months	2,331	14.8	1,719	17.6
1-<2 years	2,810	17.8	1,727	17.7
2+ years	6,803	43.2	2,794	28.7
All candidates
All candidates	15,761	100.0	9,745	100.0
OPTN/SRTR 2023 Annual Data Report

Waiting list state	2021	2022	2023
Waiting list state
Patients at start of year	11,768	11,322	10,538
Patients added during year	13,165	12,862	13,954
Patients removed during year	13,611	13,645	14,747
Patients at end of year	11,322	10,539	9,745
OPTN/SRTR 2023 Annual Data Report

Removal reason	2021	2022	2023
Removal reason
Deceased donor transplant	8,213	8,462	9,516
Living donor transplant	492	515	579
Transplant outside US	1	2	2
Patient died	1,154	1,040	943
Patient refused transplant	135	118	146
Improved, transplant not needed	1,051	983	1,101
Too sick for transplant	1,177	1,091	973
Other	1,388	1,434	1,487
OPTN/SRTR 2023 Annual Data Report

**Table LI 6:** **Demographic characteristics of adult liver transplant recipients, 2013 and 2023.** Liver transplant recipients, including retransplant recipients. Distance is computed from recipient's home zip code to the transplant center.
Characteristic	2013 N	2013 Percent	2023 N	2023 Percent
Recipient age (years)
18-34 years	335	5.7	758	7.5
35-49	976	16.5	2,358	23.3
50-64	3,645	61.6	4,741	46.8
65+	965	16.3	2,268	22.4
Sex
Female	2,021	34.1	3,925	38.8
Male	3,900	65.9	6,200	61.2
Race and ethnicity
Asian	266	4.5	418	4.1
Black	605	10.2	667	6.6
Hispanic	812	13.7	1,769	17.5
Multiracial	25	0.4	65	0.6
Native American	29	0.5	101	1.0
White	4,184	70.7	7,068	69.8
Unreported	0	0	37	0.4
Body mass index
<18.5	124	2.1	165	1.6
18.5-<25	1,685	28.5	2,633	26.0
25-<30	2,053	34.7	3,336	32.9
30-<35	1,273	21.5	2,266	22.4
35+	768	13.0	1,571	15.5
Missing	18	0.3	154	1.5
Insurance
Private	3,201	54.1	5,151	50.9
Medicare	1,686	28.5	2,629	26.0
Medicaid	774	13.1	1,924	19.0
Other/unknown	260	4.4	421	4.2
Geography
Metropolitan	4,874	82.3	8,380	82.8
Nonmetropolitan	927	15.7	1,621	16.0
Missing	120	2.0	124	1.2
Miles between recipient and center
<50 miles	3,311	55.9	5,736	56.7
50-<100	984	16.6	1,779	17.6
100-<150	539	9.1	927	9.2
150-<250	468	7.9	793	7.8
250+	551	9.3	804	7.9
Missing	68	1.1	86	0.8