Liver
OPTN/SRTR 2015 Annual Data Report: Liver
Abstract
Several notable developments in adult liver transplantation in the US occurred in 2015. The year saw the largest number of liver transplants to date, leading to reductions in median waiting time, in waitlist mortality for all model for end-stage liver disease categories, and in the number of candidates on the waiting list at the end of the year. Numbers of additions to the waiting list and of liver transplants performed in patients with hepatitis C virus infection decreased for the first time in recent years. However, other diagnoses, such as non-alcoholic fatty liver disease and alcoholic cirrhosis, became more prevalent. Despite large numbers of severely ill patients undergoing liver transplant, graft survival rates continued to improve. The number of new active candidates added to the pediatric liver transplant waiting list in 2015 was 689, down from a peak of 826 in 2005. The number of prevalent pediatric candidates (on the list on December 31 of the given year) continued to decline, to 373 active and 195 inactive candidates. The number of pediatric liver transplants peaked at 613 in 2008 and was 580 in 2015. The number of living donor pediatric liver transplants increased to its highest level, 79, in 2015; most were from donors closely related to the recipients. Pediatric graft survival rates continued to improve.
Adult Liver Transplant
Summary
The total number of adult liver transplants performed in 2015 was 7127, exceeding 7000 for the first time. The increase was attributable to both more deceased donor (n = 6768) and more living donor (n = 359) transplants. The median waiting time decreased for the first time in recent years, for all model for end-stage liver disease (MELD) strata.
In 2015, 10,640 candidates were added to the liver transplant waiting list, essentially unchanged from the previous year (n = 10,646). As of December 31, 2015, 14,046 candidates were registered on the waiting list, including 11,699 in active status.
While the increase in the number of liver transplants is encouraging, the organ shortage remains severe. During 2015, 1673 patients died without undergoing transplant and another 1227 were removed from the waiting list due to being too sick to undergo transplant.
A notable trend in 2015 was the reduction in waitlist registrations and transplants in candidates with a diagnosis of hepatitis C virus (HCV), likely attributable to the new antiviral therapies, which are highly effective in patients with end-stage liver disease. In contrast, numbers of candidates and recipients with other/unknown diagnosis increased, likely reflecting the increasing burden of obesity-related fatty liver disease.
Liver transplant outcomes continued to improve, with further reductions in the incidence of acute rejection and graft failure. Recipients of deceased donor livers in 2005 had a 10-year survival rate of 53%. As of June 30, 2015, nearly 75,000 adults were living with a functioning liver graft.
Waiting List
The number of candidates added to the liver transplant waiting list in 2015 (n = 10,640) was comparable to numbers in the recent past (n = 10,646 in 2014) (Figure LI 1). The number waiting at the end of the year decreased by 4% compared with 2014 (n = 14,046 versus 14,649), continuing a downward trend since the peak (n = 15,365) in 2011 (Figure LI 2).
A notable trend in waitlist activity in 2015 was the reduction in the number of candidates with HCV infection (Figure LI 5). HCV was no longer the most common indication for liver transplant; 26.0% of candidates had HCV infection, compared with 29.5% with other/unknown etiology. The latter category most likely reflected non-alcoholic fatty liver disease, which is difficult to specifically identify due to lack of reliable diagnostic markers. The decline in HCV registrants coincided with the widespread use of highly effective antiviral agents tolerated by patients with decompensated liver cirrhosis, introduced in late 2014. In addition, the highest rates of HCV infection occurred in the 1960s and 1970s; patients infected then are aging and becoming less likely to be transplant candidates.
Data in Figure LI 9 show 3-year waitlist outcomes for candidates listed in 2012. Slightly over 50% of candidates underwent transplant after 3 years of waiting, including 1.9% who received living donor livers. A full third of candidates died or were removed from the list, leaving 13% who were still waiting.
In another important observation, the median waiting time decreased for the first time in the past several years (Figure LI 10). This reduction occurred for patients with MELD of 35 or higher (median waiting time 9 days in 2014 and 8 days in 2015), which may be expected due to the regional share 35 policy implemented in 2013. The median waiting time also decreased for candidates with lower MELD scores (15-35), from 12.8 months in 2014 to 11.1 months in 2015. The waiting time for status 1A patients did not change (5 days in 2014 and 2015). The decrease in waiting time is due at least in part to increased donor recovery; whether the trend is sustainable remains to be seen.
The waitlist mortality statistics paralleled the shorter waiting times; for all medical urgency categories, waitlist mortality decreased in 2015 compared with 2014 (Figure LI 16). Introduction of the share 35 policy raised some concern that candidates in lower urgency categories may face higher mortality rates. Indeed, waitlist mortality in candidates with MELD scores below 35 increased slightly in 2014 compared with 2013. The 2015 data showed that those worrisome trends did not continue.
Importantly, geographic disparity in organ availability continued in 2015. There was a three-fold difference in the proportions of patients undergoing liver transplant within 5 years of listing between the donation service areas (DSAs) with the highest (84%) and lowest (28%) proportions (Figure LI 12). In general, the southeastern part of the nation reported higher proportions of patients undergoing transplant, and other regions reported lower percentages. The trend was replicated in the median MELD score at the time of transplant, with lower median MELD reported in DSAs with highest transplant rates (Figure LI 45). Further comparing Figure LI 45 and Figure LI 46 suggests that the median MELD at transplant correlated with MELD exception scores; the gap between allocation MELD and laboratory MELD was larger where the median MELD score was high. Finally, these measures of geographic disparity did not seem to have a strong correlation with waitlist mortality, as shown in Figure LI 17, suggesting that waitlist mortality may not necessarily be the most representative metric in geographic disparity in access to donated organs.
Donation/Transplant
In 2015, a record total of 7127 adult liver transplants were performed, including 6768 deceased donor transplants (Figure LI 35). The number of deceased donor transplants has been increasing steadily since its nadir in 2009 (n = 6009). Compared with 2014 (n = 6450), there was a 5% increase in 2015. The trend in donor demographics indicates that the increase in transplants was driven by donors aged 18 to 34 years in all racial/ethnic groups, with a continued increase in the proportion of anoxic deaths (Figure LI 36, Figure LI 38, Figure LI 27). The rate of organs recovered for transplant but not transplanted remained unchanged from 2014, at 9.6%, although it increased slightly for donation after circulatory death and decreased for HCV-positive organs (Figure LI 23, Figure LI 25, Figure LI 26). As is well known, there was a nearly five-fold difference in donation rates across states. Based on a relatively crude measure of liver donation per 1000 deaths, the highest donation rate was 14.8% in Delaware and the lowest 3.3% in Wyoming (Figure LI 21).
The number of living donor transplants was also higher in 2015, 343 compared with 268 in 2014, a 28% increase (Figure LI 28). This increase was attributable to related donors (net increase of 36) and to unrelated directed donors (net increase of 31). Most living donations used the right lobe (60.7%), followed by the left lateral segment (17.3%) and the left lobe (17.0%) (Figure LI 32). Domino whole liver transplants accounted for 4.2% of living donor transplants. Numbers of simultaneous liver-kidney transplants continued to increase. In 2015, 9.4% of liver transplants (n = 613) were performed with a kidney graft, up from 8.7% from the year prior.
HCV remained the most common single diagnosis among liver transplant recipients in 2015, although the total number of transplants performed in candidates with HCV infection decreased noticeably (8% reduction) (Figure LI 39). By contrast, the number of recipients with alcoholic liver disease increased by 17%, and the number with other or unknown diagnosis by 11%, the latter likely representing patients with non-alcoholic fatty liver disease.
Figure LI 7 shows an encouraging trend toward increasing deceased donor liver transplant rates among active adult waitlist candidates for all age groups. The higher number of deceased donors and the stable/decreasing number of candidates actively waiting for transplant likely increased the transplant rate. Rates remained higher for candidates with hepatocellular carcinoma (HCC) MELD exception points, and increased modestly for non-HCC candidates in 2015 (Figure LI 8). A new HCC MELD exception policy went into effect on October 8, 2015, commonly known as “HCC cap and delay,” under which HCC exception scores are granted only after 6 months of waiting and are capped at 34. Its impact on transplant rates for patients with HCC vis-a-vis those without may not be appreciated for some time, because most of the 2015 cohort underwent transplant before the policy change took effect.
Outcomes
The incidence of deceased donor graft failure continued to decrease; the most recent data (2014 transplants) show a 6-month graft failure rate of 7.8% and a 1-year rate of 10.3% (Figure LI 48). Graft failure rates for living donor transplants did not change appreciably (Figure LI 49). Six-month and 1-year graft failure rates were lowest in 2008 at 6.6% and 9.4%, respectively; they were 12.5% and 15.1%, respectively, for transplants performed in 2014. The cause of this increase is uncertain; relatively small numbers of living donor transplants performed between 2008 and 2014 and increasing severity of liver disease in recent recipients are possible explanations. Figure LI 50, Figure LI 51, Figure LI 52, Figure LI 53, Figure LI 54, and Figure LI 55, and Figure LI 61, Figure LI 62, Figure LI 63, and Figure LI 64 show graft and patient survival data, respectively. Pretransplant factors such as age, MELD score, and liver disease diagnosis influenced transplant outcomes in expected directions.
The incidence of acute rejection within the first year after transplant continued to decrease in all age groups (Figure LI 59). Calcineurin inhibitors remained the mainstay for immunosuppression in adult liver transplant recipients, although use of mammalian target of rapamycin (mTOR) inhibitors initiated some time after the first month has increased gradually (Figure LI 41, Figure LI 43).
Many liver transplant recipients enjoyed long-term graft survival. For patients who underwent liver transplant in 2008-2010, the 5-year overall survival rate was 73.6% (Figure LI 61). As of June 30, 2015, 74,945 liver transplant recipients were alive with a functioning graft (Figure LI 58).
Pediatric Transplant
Waiting List
In 2015, the number of new active candidates added to the pediatric liver transplant waiting list was 689, down from a peak of 826 in 2005. Very few candidates (21) were added as inactive (Figure LI 67). The number of prevalent candidates (on the list on December 31 of the given year) continued to decline, to 373 active and 195 inactive candidates (Figure LI 68). The proportion of children aged 1 to 5 years has increased over the past several years to a peak of 34.1% in 2015; 32.6% were aged 11 to 17 years, 19.3% younger than 1 year, and 13.9% 6 to 10 years (Figure LI 69). White candidates continued to represent the largest racial/ethnic group on the waiting list in 2015 (52.0%), followed by Hispanic (22.8%), black (15.3%), and Asian candidates (7.2%) (Figure LI 70). Most (65.4%) candidates had been waiting for less than 1 year, 11.1% for 1 to less than 2 years, 9.1% for 2 to less than 4 years, and 14.3% for 4 or more years (Figure LI 71). A shift occurred over the past decade to more candidates with MELD/pediatric end-stage liver disease (PELD) scores greater than 35 (14.6% in 2015 vs. 6.6% in 2004), more candidates listed as status 1A/1B (25.0% in 2015 vs. 9.2% in 2004), and fewer candidates with MELD/PELD scores below 15 (17.8% in 2015 vs. 33.4% in 2004) or listed as inactive (12.4% in 2015 vs. 25.5% in 2005) (Figure LI 72).
Comparing pediatric liver waitlist candidates from 2005 to 2015 shows little change in age, sex, or race. The most common primary diagnosis remained cholestatic disease (43.8%) in 2015. Acute liver failure was the primary diagnosis in 6.3% of candidates in 2005 and in 3.5% in 2015. Waiting time shifted such that 52.7% of candidates waited for less than 1 year in 2015, compared with 36.4% in 2005. Candidates listed for multi-organ transplants including liver increased over time. Liver-kidney transplant candidates accounted for only 1.5% of pediatric liver transplant candidates in 2005 and for 4.3% in 2015. The proportion of liver-pancreas-intestine transplant candidates increased from 2.5% in 2005 to 12.3% in 2015 (Table LI 9). Among candidates removed from the waiting list in 2015, 70.1% received a deceased donor liver, 11.7% received a living donor liver (up from 5.9% in 2013), 4.2% died, 8.8% were removed from the list because their condition improved, and 3.2% were considered too sick to undergo transplant (Table LI 11). Approximately 69% of candidates newly listed in 2012 underwent deceased donor transplant within 3 years, 6.9% underwent living donor transplant, 5.8% died, 12.7% were removed from the list, and 5.7% were still waiting (Figure LI 73). In 2015, the rate of deceased donor transplant among active pediatric candidates was 129.0 per 100 active waitlist years (Figure LI 74). While rates were highest for candidates aged younger than 1 year (223.1 per 100 active waitlist years), this was down form a peak of 275.6 in 2013. The lowest rates were for candidates aged 11 years or older (89.4 per 100 active waitlist years). Regarding medical urgency status, transplant rates were highest (197.0 per 100 active waitlist years) for candidates with MELD/PELD 35 or higher, compared with 25.8 for those with MELD/PELD less than 15 (Figure LI 75). Pretransplant mortality decreased for all age groups, to 5.5 deaths per 100 waitlist years in 2014-2015 (Figure LI 76). The pretransplant mortality rate was highest for candidates aged younger than 1 year, at 10.4 deaths per 100 waitlist years in 2014-2015, but it has steadily declined over the past decade from a peak of 40.4 in 2006-2007.
Transplant
The number of pediatric liver transplants peaked at 613 in 2008 and was 580 in 2015 (Figure LI 78). The number of pediatric living donor liver transplants increased to its highest level, 79, in 2015, with most from donors closely related to the recipients (Figure LI 79). The age groups younger than 6 years and 11 to 17 years each received 14% of livers from living donors (Figure LI 80). In 2015, 27 centers were performing pediatric-only liver transplants, compared with 84 performing adult-only transplants and 25 performing transplants in both adults and children (Figure LI 81). Over the past decade of pediatric liver transplant, recipient age, sex, and racial distributions have changed little (Table LI 12). Cholestatic disease remained the leading cause of liver failure (44.6%). In 2013-2015, 8.6% of liver transplant recipients had undergone previous transplant, a decrease from 12.1% a decade earlier. Most (62.3%) pediatric liver transplant recipients were not hospitalized before transplant and fewer were in the intensive care unit, 29.0% in 2003-2005 vs. 20.7% in 2013-2015. Regarding medical urgency status, MELD/PELD exception use increased from 22.1% in 2003-2005 to 38.7% in 2013-2015. Thirty-six percent of recipients underwent transplant as status 1A/1B, and 19.7% had MELD/PELD scores of 35 or higher, compared with only 9.0% a decade earlier. The most common MELD/PELD score at the time of transplant was 15 to 29 (22.3%). Types of liver transplant procedures in pediatric recipients changed little over the past decade; 63.9% of patients received a whole liver in 2013-2015, 21.4% received a partial liver (i.e., less than a whole liver was transplanted, possibly from a living donor, and the remainder was not), and 14.7% received a split liver (i.e., two recipients, usually an adult and a child, received one deceased donor liver). ABO-incompatible liver transplants occurred in 4.4% of recipients in 2013-2015, up from 1.7% in the earlier era.
Immunosuppression and Outcomes
In 2015, 65.3% of pediatric liver transplant recipients received no induction therapy, 23.1% received interleukin-2 receptor antagonists, and 12.5% received a T-cell depleting agent, (Figure LI 82). The most commonly used initial immunosuppression agents included tacrolimus (94.0%) (Figure LI 83), steroids (78.5%) (Figure LI 86), and mycophenolate mofetil (34.7%) (Figure LI 84). Use of mTOR inhibitors at the time of transplant was minimal (2.2%), but increased to 9.0% at 1 year posttransplant (Figure LI 85). At 1 year posttransplant, 58.4% of recipients were still receiving steroids (Figure LI 86). Graft survival continued to improve over the past decade among recipients of deceased donor and living donor livers. Graft failure occurred in 8.0% at 6 months and 9.2% at 1 year among deceased donor liver transplants performed in 2014, in 14.3% at 3 years for transplants performed in 2012, in 17.3% at 5 years for transplants performed in 2010, and in 32.0% at 10 years for transplants performed in 2005 (Figure LI 88). Graft failure occurred in 6.2% at 6 months and 6.2% at 1 year posttransplant among living donor transplants performed in 2013-2014, in 6.9% at 3 years for transplants performed in 2011-2012, in 17.1% at 5 years for transplants performed in 2009-2010, and in 20.8% at 10 years for transplants performed 2003-2004 (Figure LI 89). By age, 5-year graft survival was 75.0% for recipients aged younger than 1 year, 78.2% for ages 1 to 5 years, 87.0% for ages 6 to 10 years, and 79.1% for ages 11 to 17 years (Figure LI 90). Recipients who underwent transplant with a MELD/PELD less than 20 had 5-year graft survival of 86.0%, compared with 76.3% for recipients who underwent transplant as status 1A/1B or with a MELD/PELD greater than 20 (Figure LI 92). Five-year graft survival was 79.8% for recipients of a first liver transplant, compared with 68.8% for retransplant recipients (Figure LI 93). In 2013-2014, the incidence of acute rejection was 25.9% overall, varying from 22.5% in recipients aged 6 to 10 years to 27.2% in those ages 1 to 5 years (Figure LI 94). The incidence of posttransplant lymphoproliferative disorder was 4.6% at 5 years posttransplant for recipients who were negative for Epstein-Barr virus and 2.8% for those who were positive (Figure LI 95). Among liver transplants from 2006 to 2010, the overall 5-year patient survival was 84.6%, varying from 82.3% for recipients aged younger than 1 year to 91.0% for those aged 6 to 10 years (Figure LI 96). By primary diagnosis, cholestatic disease and acute liver failure were associated with the best patient survival (Figure LI 97). Of deceased donor transplant recipients in 2008-2010, 13.5% died within 5 years of transplant (Figure LI 99). The leading cause of death was infection (2.3%), followed by cardio/cerebrovascular complications (1.8%).
Figure List
Waiting list
Figure LI 1. New adult candidates added to the liver transplant waiting list
Figure LI 2. Adults listed for liver transplant on December 31 each year
Figure LI 3. Distribution of adults waiting for liver transplant by age
Figure LI 4. Distribution of adults waiting for liver transplant by race
Figure LI 5. Distribution of adults waiting for liver transplant by diagnosis
Figure LI 6. Distribution of adults waiting for liver transplant by medical urgency
Figure LI 7. Deceased donor liver transplant rates among active adult waitlist candidates by age
Figure LI 8. Deceased donor liver transplant rates among active adult waitlist candidates by sex and HCC exception status
Figure LI 9. Three-year outcomes for adults waiting for liver transplant, new listings in 2012
Figure LI 10. Median months to liver transplant for waitlisted adults
Figure LI 11. Percentage of adults who underwent deceased donor liver transplant within a given time period of listing
Figure LI 12. Percentage of adults who underwent deceased donor liver transplant within 5 years of listing in 2010 by DSA
Figure LI 13. Pretransplant mortality rates among adults waitlisted for liver transplant by age
Figure LI 14. Pretransplant mortality rates among adults waitlisted for liver transplant by race
Figure LI 15. Pretransplant mortality rates among adults waitlisted for liver transplant by diagnosis
Figure LI 16. Pretransplant mortality rates among adults waitlisted for liver transplant by medical urgency
Figure LI 17. Pretransplant mortality rates among adults waitlisted for liver transplant in 2014-2015, by DSA
Figure LI 18. Deaths within six months after removal among adult liver walitlist candidates
Deceased donation
Figure LI 19. Deceased liver donors by age
Figure LI 20. Deceased liver donors by race
Figure LI 21. Deceased donor liver donation rates (per 1000 deaths) by state, 2012-2014
Figure LI 22. Rates of livers recovered for transplant and not transplanted by age
Figure LI 23. Rates of livers recovered for transplant and not transplanted by sex
Figure LI 24. Rates of livers recovered for transplant and not transplanted by race
Figure LI 25. Rates of livers recovered for transplant and not transplanted by DCD status
Figure LI 26. Rates of livers recovered for transplant and not transplanted by HCV status
Figure LI 27. Cause of death among deceased liver donors
Living donation
Figure LI 28. Liver transplants from living donors by donor relation
Figure LI 29. Living liver donors by age
Figure LI 30. Living liver donors by sex
Figure LI 31. Living liver donors by race
Figure LI 32. Living donor liver transplant graft type
Figure LI 33. Rehospitalization in the first 6 weeks, 6 months, and 1 year among living liver donors, 2010-2014
Figure LI 34. BMI among living liver donors
Transplant
Figure LI 35. Total liver transplants
Figure LI 36. Total liver transplants by age
Figure LI 37. Total liver transplants by sex
Figure LI 38. Total liver transplants by race
Figure LI 39. Total liver transplants by diagnosis
Figure LI 40. Induction agent use in adult liver transplant recipients
Figure LI 41. Calcineurin inhibitor use in adult liver transplant recipients
Figure LI 42. Anti-metabolite use in adult liver transplant recipients
Figure LI 43. mTOR inhibitor use in adult liver transplant recipients
Figure LI 44. Steroid use in adult liver transplant recipients
Figure LI 45. Median MELD scores for adult deceased donor liver transplant recipients by DSA, 2015
Figure LI 46. Differences in lab MELD and allocation MELD scores among liver transplant recipients by DSA, 2015
Figure LI 47. Total HLA A, B, and DR mismatches among adult deceased donor liver-kidney transplant recipients, 2011-2015
Outcomes
Figure LI 48. Graft failure among adult deceased donor liver transplant recipients
Figure LI 49. Graft failure among adult living donor liver transplant recipients
Figure LI 50. Graft survival among adult deceased donor liver transplant recipients, 2010, by age
Figure LI 51. Graft survival among adult deceased donor liver transplant recipients, 2010, by diagnosis
Figure LI 52. Graft survival among adult deceased donor liver transplant recipients, 2010, by medical urgency
Figure LI 53. Graft survival among adult deceased donor liver transplant recipients, 2010, by DCD status
Figure LI 54. Graft survival among adult deceased donor liver transplant recipients, 2010, by retransplant status
Figure LI 55. Graft survival among adult deceased donor liver transplant recipients, 2010, by HCC status
Figure LI 56. Graft survival among adult living donor liver transplant recipients, 2007-2010, by diagnosis
Figure LI 57. Graft survival among adult living donor liver transplant recipients, 2007-2010, by medical urgency
Figure LI 58. Recipients alive with a functioning liver graft on June 30 of the year, by age at transplant
Figure LI 59. Incidence of acute rejection by 1 year posttransplant among adult liver transplant recipients by age
Figure LI 60. Incidence of PTLD among adult liver transplant recipients by recipient EBV status at transplant, 2009-2013
Figure LI 61. Patient survival among adult deceased donor liver transplant recipients, 2008-2010, by age
Figure LI 62. Patient survival among adult deceased donor liver transplant recipients, 2008-2010, by diagnosis
Figure LI 63. Patient survival among adult deceased donor liver transplant recipients, 2008-2010, by retransplant
Figure LI 64. Patient survival among adult deceased donor liver transplant recipients, 2008-2010, by medical urgency
Figure LI 65. Patient survival among adult living donor liver transplant recipients, 2007-2010, by diagnosis
Figure LI 66. Patient survival among adult living donor liver transplant recipients, 2007-2010, by medical urgency
Pediatric transplant
Figure LI 67. New pediatric candidates added to the liver transplant waiting list
Figure LI 68. Pediatric candidates listed for liver transplant on December 31 each year
Figure LI 69. Distribution of pediatric candidates waiting for liver transplant by age
Figure LI 70. Distribution of pediatric candidates waiting for liver transplant by race
Figure LI 71. Distribution of pediatric candidates waiting for liver transplant by waiting time
Figure LI 72. Distribution of pediatric candidates waiting for liver transplant by medical urgency
Figure LI 73. Three-year outcomes for newly listed pediatric candidates waiting for liver transplant, 2012
Figure LI 74. Deceased donor liver transplant rates among active pediatric waitlist candidates by age
Figure LI 75. Deceased donor liver transplant rates among active pediatric waitlist candidates by medical urgency
Figure LI 76. Pretransplant mortality rates among pediatrics waitlisted for liver transplant by age
Figure LI 77. Pretransplant mortality rates among pediatrics waitlisted for liver transplant by race
Figure LI 78. Pediatric liver transplants by donor type
Figure LI 79. Pediatric liver transplants from living donors by relation
Figure LI 80. Percent of pediatric liver transplants from living donors by recipient age
Figure LI 81. Number of centers performing pediatric and adult liver transplants by center's age mix
Figure LI 82. Induction agent use in pediatric liver transplant recipients
Figure LI 83. Calcineurin inhibitor use in pedatric liver transplant recipients
Figure LI 84. Anti-metabolite use in pedatric liver transplant recipients
Figure LI 85. mTOR inhibitor use in pediatric liver transplant recipients
Figure LI 86. Steroid use in pedatric liver transplant recipients
Figure LI 87. Total HLA A, B, and DR mismatches among pediatric deceased donor liver-kidney transplant recipients, 2011-2015
Figure LI 88. Graft failure among pediatric deceased donor liver transplant recipients
Figure LI 89. Graft failure among pediatric living donor liver transplant recipients
Figure LI 90. Graft survival among pediatric deceased donor liver transplant recipients, 2006-2010, by age
Figure LI 91. Graft survival among pediatric deceased donor liver transplant recipients, 2006-2010, by diagnosis
Figure LI 92. Graft survival among pediatric deceased donor liver transplant recipients, 2006-2010, by medical urgency
Figure LI 93. Graft survival among pediatric deceased donor liver transplant recipients, 2006-2010, by retransplant
Figure LI 94. Incidence of acute rejection by 1 year posttransplant among pediatric liver transplant recipients by age
Figure LI 95. Incidence of PTLD among pediatric liver transplant recipients by recipient EBV status at transplant, 2003-2013
Figure LI 96. Patient survival among pediatric liver transplant recipients, 2006-2010, by age
Figure LI 97. Patient survival among pediatric liver transplant recipients, 2006-2010, by diagnosis
Figure LI 98. One-year cumulative incidence of death by cause among pediatric liver recipients, 2009-2014
Figure LI 99. Five-year cumulative incidence of death by cause among pediatric liver recipients, 2008-2010
Table List
Waiting list
Table LI 1. Characteristics of adults on the liver transplant waiting list on December 31, 2005 and December 31, 2015
Table LI 2. Liver transplant waitlist activity among adults
Table LI 3. Removal reason among adult liver transplant candidates
Living donation
Table LI 4. Complications among living liver donors, 2011-2015
Table LI 5. Living liver donor deaths, 2011-2015, by number of days after donation
Transplant
Table LI 6. Characteristics of adult liver transplant recipients, 2005 and 2015
Table LI 7. Adult deceased donor liver donor-recipient serology matching, 2011-2015
Table LI 8. Adult living donor liver donor-recipient serology matching, 2011-2015
Pediatric transplant
Table LI 9. Characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2005 and December 31, 2015
Table LI 10. Liver transplant waitlist activity among pediatric candidates
Table LI 11. Removal reason among pediatric liver transplant candidates
Table LI 12. Characteristics of pediatric liver transplant recipients, 2003-2005 and 2013-2015
Table LI 1 Characteristics of adults on the liver transplant waiting list on December 31, 2005 and December 31, 2015 Candidates waiting for transplant on December 31, 2005, and December 31, 2015, regardless of first listing date; active/inactive status is on this date, and multiple listings are not counted. HCC, hepatocellular carcinoma; HCV, hepatitis C virus.
Characteristic | 2005, N | 2005, Percent | 2015, N | 2015, Percent |
Age: 18-34 years | 648 | 4.1% |
616 | 4.4% | Age: 35-49 years
| 3722 | 23.7% | 2011 |
14.3% | Age: 50-64 years | 9513 |
60.5% | 8303 | 59.1% |
Age: ≥65 years | 1845 | 11.7% |
3117 | 22.2% | Sex: Female
| 6381 | 40.6% | 5251 |
37.4% | Sex: Male | 9347 |
59.4% | 8796 | 62.6% |
Race/ethnicity: White | 11,430 | 72.7% |
9655 | 68.7% | Race/ethnicity: Black
| 1049 | 6.7% | 1097 |
7.8% | Race/ethnicity: Hispanic | 2379 |
15.1% | 2358 | 16.8% |
Race/ethnicity: Asian | 755 | 4.8% |
768 | 5.5% |
Race/ethnicity: Other/unknown | 115 | 0.7% |
169 | 1.2% |
Diagnosis: Acute liver failure | 616 | 3.9% |
268 | 1.9% | Diagnosis: HCV
| 4908 | 31.2% | 3675 |
26.2% | Diagnosis: Alcoholic liver disease
| 3603 | 22.9% | 3634 |
25.9% | Diagnosis: Cholestatic disease
| 1683 | 10.7% | 1164 |
8.3% | Diagnosis: Malignancy | 376 |
2.4% | 1014 | 7.2% |
Diagnosis: Other/unknown | 4542 | 28.9% |
4292 | 30.6% | Transplant history: First
| 14,970 | 95.2% | 13,678 |
97.4% | Transplant history: Retransplant
| 758 | 4.8% | 369 |
2.6% | Blood type: A | 5774 |
36.7% | 5425 | 38.6% |
Blood type: B | 1808 | 11.5% |
1631 | 11.6% | Blood type: AB
| 411 | 2.6% | 333 |
2.4% | Blood type: O | 7735 |
49.2% | 6658 | 47.4% |
Wait time: < 1 year | 4487 | 28.5% |
5552 | 39.5% | Wait time: 1-< 2 years
| 2757 | 17.5% | 2678 |
19.1% | Wait time: 2-< 3 years | 2059 |
13.1% | 1533 | 10.9% |
Wait time: 3-< 4 years | 1518 | 9.7% |
1087 | 7.7% | Wait time: 4-< 5 years
| 1448 | 9.2% | 795 |
5.7% | Wait time: ≥ 5 years | 3459 |
22.0% | 2402 | 17.1% |
Medical urgency: Status 1A | 7 | 0.0% |
2 | 0.0% |
Medical urgency: MELD ≥ 35 | 38 | 0.2% |
79 | 0.6% | Medical urgency: MELD 30-34
| 28 | 0.2% | 370 |
2.6% | Medical urgency: MELD 15-29
| 2751 | 17.5% | 4572 |
32.5% | Medical urgency: MELD < 15
| 9319 | 59.3% | 6676 |
47.5% | Medical urgency: Unknown | 0 |
0.0% | 1 | 0.0% |
Medical urgency: Inactive | 3585 | 22.8% |
2347 | 16.7% | Exception status: None
| 15,238 | 96.9% | 11,651 |
82.9% | Exception status: HCC | 339 |
2.2% | 1630 | 11.6% |
Exception status: Other | 151 | 1.0% |
766 | 5.5% | Tx type: Liver alone
| 15,376 | 97.8% | 13,047 |
92.9% | Tx type: Liver-kidney | 307 |
2.0% | 926 | 6.6% |
Tx type: Liver-pancreas-intestine | 18 | 0.1% |
26 | 0.2% | Tx type: Liver-heart
| 11 | 0.1% | 30 |
0.2% | Tx type: Other | 16 |
0.1% | 18 | 0.1% |
All candidates | 15,728 | 100.0% |
14,047 | 100.0% |
Table LI 2 Liver transplant waitlist activity among adults Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.
Waiting list state | 2013 | 2014 | 2015 |
Patients at start of year | 15,140 | 15,018 |
14,622 | Patients added during year
| 10,501 | 10,646 | 10,640 |
Patients removed during year | 10,594 | 11,015 |
11,215 | Patients at end of year | 15,047 |
14,649 | 14,047 |
Table LI 3 Removal reason among adult liver transplant candidates Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason | 2013 | 2014 | 2015 |
Deceased donor transplant | 5641 | 5878 |
6196 | Living donor transplant | 209 |
228 | 278 | Transplant outside US
| 3 | 10 | 2 |
Patient died | 1785 | 1830 |
1673 | Patient refused transplant | 80 |
103 | 92 |
Improved, transplant not needed | 588 | 690 |
777 | Too sick for transplant | 1218 |
1286 | 1227 | Other
| 1070 | 990 | 970 |
Table LI 4 Complications among living liver donors, 2011-2015 Complications reported on the OPTN Living Donor Registration Form.
Clavien Grade 1, bilious Jackson Pratt drainage more than 10 days; Clavien Grade 2, interventional procedure (endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, percutaneous drainage, etc.); Clavien Grade 3, surgical intervention. Clavien grades refer to biliary complications. Domino liver donors excluded.
Level | N | Pct | Biliary complication: Yes
| 46 | 3.5% | Biliary complication: No
| 1272 | 95.9% |
Biliary complication: Unknown | 9 | 0.7% |
Clavien Grade: 1 | 13 | 1.0% |
Clavien Grade: 2 | 26 | 2.0% |
Clavien Grade: 3 | 10 | 0.8% |
Vascular complication, requiring intervention: Yes | 15 |
1.1% | Vascular complication, requiring intervention: No
| 1303 | 98.2% |
Vascular complication, requiring intervention: Unknown | 9 |
0.7% | Other complication, requiring intervention: Yes
| 101 | 7.6% |
Other complication, requiring intervention: No | 1213 |
91.4% | Other complication, requiring intervention: Unknown
| 13 | 1.0% | Re-operation: Yes
| 31 | 2.3% | Re-operation: No
| 1289 | 97.1% | Re-operation: Unknown
| 7 | 0.5% |
Table LI 5 Living liver donor deaths, 2011-2015, by number of days after donation Living liver donors, excluding domino livers. Numbers of deaths reported to OPTN or the Social Security Administration. No deaths occurred within a year of donation among living liver donors, 2011-2015.
Cause | 0-30 days | 31-90 days | 91-365 days |
Suicide | 0 | 0 |
0 | Accident/homicide | 0 |
0 | 0 | Medical
| 0 | 0 | 0 |
Cancer | 0 | 0 |
0 | Unknown | 0 |
0 | 0 | TOTAL
| 0 | 0 | 0 |
Table LI 6 Characteristics of adult liver transplant recipients, 2005 and 2015 Adult liver transplant recipients, including retransplants. HCC, hepatocellular carcinoma; HCV, hepatitis C virus.
Characteristic | 2005, N | 2005, Percent | 2015, N | 2015, Percent |
Age: 18-34 years | 390 | 6.6% |
408 | 6.2% | Age: 35-49 years
| 1510 | 25.7% | 1071 |
16.4% | Age: 50-64 years | 3345 |
56.9% | 3828 | 58.5% |
Age: ≥65 years | 630 | 10.7% |
1240 | 18.9% | Sex: Female
| 1893 | 32.2% | 2201 |
33.6% | Sex: Male | 3982 |
67.8% | 4346 | 66.4% |
Race/ethnicity: White | 4322 | 73.6% |
4614 | 70.5% | Race/ethnicity: Black
| 529 | 9.0% | 643 |
9.8% | Race/ethnicity: Hispanic | 719 |
12.2% | 911 | 13.9% |
Race/ethnicity: Asian | 254 | 4.3% |
293 | 4.5% |
Race/ethnicity: Other/unknown | 51 | 0.9% |
86 | 1.3% |
Diagnosis: Acute liver failure | 381 | 6.5% |
213 | 3.3% | Diagnosis: HCV
| 1505 | 25.6% | 1486 |
22.7% | Diagnosis: Alcoholic liver disease
| 1226 | 20.9% | 1377 |
21.0% | Diagnosis: Cholestatic disease
| 522 | 8.9% | 576 |
8.8% | Diagnosis: Malignancy | 693 |
11.8% | 1226 | 18.7% |
Diagnosis: Other/unknown | 1548 | 26.3% |
1669 | 25.5% | Transplant history: First
| 5373 | 91.5% | 6264 |
95.7% | Transplant history: Retransplant
| 502 | 8.5% | 283 |
4.3% | Blood type: A | 2245 |
38.2% | 2368 | 36.2% |
Blood type: B | 731 | 12.4% |
898 | 13.7% | Blood type: AB
| 290 | 4.9% | 295 |
4.5% | Blood type: O | 2609 |
44.4% | 2986 | 45.6% |
Wait time: < 31 days | 2228 | 37.9% |
2017 | 30.8% | Wait time: 31-60 days
| 696 | 11.8% | 653 |
10.0% | Wait time: 61-90 days | 415 |
7.1% | 438 | 6.7% |
Wait time: 3-< 6 months | 833 | 14.2% |
1015 | 15.5% | Wait time: 6-< 12 months
| 693 | 11.8% | 989 |
15.1% | Wait time: 1-< 2 years | 453 |
7.7% | 895 | 13.7% |
Wait time: 2-< 3 years | 200 | 3.4% |
216 | 3.3% | Wait time: ≥ 3 years
| 356 | 6.1% | 324 |
4.9% | Wait time: Unknown | 1 |
0.0% | 0 | 0.0% |
BMI: < 18.5 kg/m2 | 130 | 2.2% |
121 | 1.8% |
BMI: 18.5-< 25 kg/m2 | 1854 | 31.6% |
1818 | 27.8% |
BMI: 25-< 28 kg/m2 | 1366 | 23.3% |
1370 | 20.9% |
BMI: 28-< 30 kg/m2 | 749 | 12.7% |
892 | 13.6% |
BMI: 30-< 35 kg/m2 | 1138 | 19.4% |
1438 | 22.0% |
BMI: ≥ 35 kg/m2 | 625 | 10.6% |
902 | 13.8% | BMI: unknown
| 13 | 0.2% | 6 |
0.1% | Medical condition: Hospitalized in ICU
| 791 | 13.5% | 1042 |
15.9% | Medical condition: Hospitalized, not ICU
| 992 | 16.9% | 1286 |
19.6% | Medical condition: Not hospitalized
| 4091 | 69.6% | 4167 |
63.6% | Medical condition: Hospitalization unkno
| 1 | 0.0% | 52 |
0.8% | Medical urgency: Status 1A | 374 |
6.4% | 181 | 2.8% |
Medical urgency: MELD ≥ 35 | 652 | 11.1% |
1676 | 25.6% |
Medical urgency: MELD 30-34 | 567 | 9.7% |
937 | 14.3% |
Medical urgency: MELD 15-29 | 3783 | 64.4% |
3522 | 53.8% |
Medical urgency: MELD < 15 | 491 | 8.4% |
229 | 3.5% | Medical urgency: Unknown
| 8 | 0.1% | 2 |
0.0% | HCC exception | 1031 |
17.5% | 1726 | 26.4% |
Other MELD exception | 466 | 7.9% |
916 | 14.0% | Insurance: Private
| 3593 | 61.2% | 3529 |
53.9% | Insurance: Medicare | 1172 |
19.9% | 1814 | 27.7% |
Insurance: Medicaid | 838 | 14.3% |
871 | 13.3% | Insurance: Unknown
| 272 | 4.6% | 333 |
5.1% | Procedure: Whole liver | 5541 |
94.3% | 6208 | 94.8% |
Procedure: Partial liver | 255 | 4.3% |
273 | 4.2% | Procedure: Split liver
| 79 | 1.3% | 66 |
1.0% | Tx type: Liver only | 5504 |
93.7% | 5866 | 89.6% |
Tx type: Liver-kidney | 329 | 5.6% |
613 | 9.4% | Tx type: Other
| 42 | 0.7% | 68 |
1.0% | Donor type: Deceased | 5611 |
95.5% | 6267 | 95.7% |
Donor type: Living | 264 | 4.5% |
280 | 4.3% | Diabetes
| 1208 | 20.6% | 1824 |
27.9% | Incident tumor | 214 |
3.6% | 22 | 0.3% |
All recipients | 5875 | 100.0% |
6547 | 100.0% |
Table LI 7 Adult deceased donor liver donor-recipient serology matching, 2011-2015 Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. If all fields are unknown, incomplete, or pending, the person is categorized as unknown for that serology; otherwise, serology is assumed negative. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HB, hepatitis B; HCV, hepatitis C virus; HIV, human immunodeficiency virus.
Donor | Recipient | CMV | EBV | HB core | HB surf. ant. | HCV | HIV |
D- | R- | 9.4% |
0.5% | 71.9% | 92.3% |
56.5% | 93.8% | D-
| R+ | 18.6% | 3.4% | 18.5% |
4.3% | 36.2% | 0.5% |
D- | R unk | 7.7% |
1.2% | 4.7% | 3.2% |
2.5% | 4.9% | D+
| R- | 16.0% | 11.2% | 3.1% |
0.0% | 0.1% | 0.0% |
D+ | R+ | 34.5% |
62.0% | 1.7% | 0.0% |
4.4% | 0.0% | D+
| R unk | 13.6% | 21.5% | 0.2% |
0.0% | 0.1% | 0.0% |
D unk | R- | 0.1% |
0.0% | 0.0% | 0.1% |
0.0% | 0.8% | D unk
| R+ | 0.2% | 0.1% | 0.0% |
0.0% | 0.0% | 0.0% |
D unk | R unk | 0.1% |
0.0% | 0.0% | 0.0% |
0.0% | 0.0% |
Table LI 8 Adult living donor liver donor-recipient serology matching, 2011-2015 Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. If all fields are unknown, incomplete, or pending, the person is categorized as unknown for that serology; otherwise, serology is assumed negative. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HB, hepatitis B; HCV, hepatitis C virus; HIV, human immunodeficiency virus.
Donor | Recipient | CMV | EBV | HB core | HB surf. ant. | HCV | HIV |
D- | R- | 21.4% |
1.8% | 76.7% | 85.3% |
64.9% | 66.7% | D-
| R+ | 19.1% | 8.8% | 10.9% |
2.4% | 26.2% | 0.2% |
D- | R unk | 13.0% |
2.3% | 3.1% | 5.4% |
2.8% | 2.3% | D+
| R- | 10.2% | 8.6% | 1.0% |
0.3% | 0.5% | 0.0% |
D+ | R+ | 20.5% |
56.5% | 0.7% | 0.0% |
0.2% | 0.0% | D+
| R unk | 10.6% | 5.7% | 0.0% |
0.0% | 0.0% | 0.0% |
D unk | R- | 1.9% |
0.8% | 4.7% | 5.7% |
3.6% | 26.5% | D unk
| R+ | 2.5% | 4.1% | 0.6% |
0.1% | 0.9% | 0.0% |
D unk | R unk | 0.8% |
11.4% | 2.3% | 0.8% |
0.8% | 4.4% |
Table LI 9 Characteristics of pediatric candidates on the liver transplant waiting list on December 31, 2005 and December 31, 2015 Candidates aged younger than 18 years waiting for transplant on December 31, 2005, and December 31, 2015, regardless of first listing date; active/inactive status is on this date, and multiple listings are not counted. Pediatric candidates aged 12 to 17 years can be assigned MELD or PELD scores.HCC, hepatocellular carcinoma; HCV, hepatitis C virus.
Characteristic | 2005, N | 2005, Percent | 2015, N | 2015, Percent |
Age: < 1 year | 73 | 9.2% |
40 | 8.6% | Age: 1-5 years
| 295 | 37.2% | 178 |
38.4% | Age: 6-10 years | 176 |
22.2% | 95 | 20.5% |
Age: 11-17 years | 249 | 31.4% |
150 | 32.4% | Sex: Female
| 408 | 51.5% | 245 |
52.9% | Sex: Male | 385 |
48.5% | 218 | 47.1% |
Race/ethnicity: White | 433 | 54.6% |
234 | 50.5% | Race/ethnicity: Black
| 122 | 15.4% | 64 |
13.8% | Race/ethnicity: Hispanic | 165 |
20.8% | 120 | 25.9% |
Race/ethnicity: Asian | 56 | 7.1% |
37 | 8.0% |
Race/ethnicity: Other/unknown | 17 | 2.1% |
8 | 1.7% |
Diagnosis: Acute liver failure | 50 | 6.3% |
16 | 3.5% | Diagnosis: HCV
| 4 | 0.5% | 2 |
0.4% | Diagnosis: Cholestatic disease
| 371 | 46.8% | 203 |
43.8% | Diagnosis: Malignancy | 80 |
10.1% | 47 | 10.2% |
Diagnosis: Other/unknown | 288 | 36.3% |
195 | 42.1% | Transplant history: First
| 663 | 83.6% | 406 |
87.7% | Transplant history: Retransplant
| 130 | 16.4% | 57 |
12.3% | Blood type: A | 232 |
29.3% | 130 | 28.1% |
Blood type: B | 90 | 11.3% |
63 | 13.6% | Blood type: AB
| 16 | 2.0% | 10 |
2.2% | Blood type: O | 455 |
57.4% | 260 | 56.2% |
Wait time: < 1 year | 289 | 36.4% |
244 | 52.7% | Wait time: 1-< 2 years
| 108 | 13.6% | 67 |
14.5% | Wait time: 2-< 3 years | 70 |
8.8% | 49 | 10.6% |
Wait time: 3-< 4 years | 60 | 7.6% |
26 | 5.6% | Wait time: 4-< 5 years
| 70 | 8.8% | 18 |
3.9% | Wait time: ≥ 5 years | 196 |
24.7% | 59 | 12.7% |
Medical urgency: Status 1A/1B | 10 | 1.3% |
19 | 4.1% |
Medical urgency: MELD/PELD ≥ 35 | 28 |
3.5% | 54 | 11.7% |
Medical urgency: MELD/PELD 30-34 | 44 | 5.5% |
43 | 9.3% |
Medical urgency: MELD/PELD 15-29 | 89 | 11.2% |
87 | 18.8% |
Medical urgency: MELD/PELD < 15 | 285 | 35.9% |
119 | 25.7% | Medical urgency: Inactive
| 337 | 42.5% | 141 |
30.5% | Exception status: None | 720 |
90.8% | 331 | 71.5% |
Exception status: HCC | 0 | 0.0% |
1 | 0.2% | Exception status: Other
| 73 | 9.2% | 131 |
28.3% | Tx type: Liver alone | 704 |
88.8% | 381 | 82.3% |
Tx type: Liver-kidney | 12 | 1.5% |
20 | 4.3% |
Tx type: Liver-pancreas-intestine | 20 | 2.5% |
57 | 12.3% | Tx type: Liver-heart
| 0 | 0.0% | 1 |
0.2% | Tx type: Other | 57 |
7.2% | 4 | 0.9% |
All candidates | 793 | 100.0% |
463 | 100.0% |
Table LI 10 Liver transplant waitlist activity among pediatric candidates Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.
Waiting list state | 2013 | 2014 | 2015 |
Patients at start of year | 582 | 581 |
574 | Patients added during year | 707 |
669 | 710 | Patients removed during year
| 708 | 676 | 716 |
Patients at end of year | 581 | 574 |
568 |
Table LI 11 Removal reason among pediatric liver transplant candidates Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason | 2013 | 2014 | 2015 |
Deceased donor transplant | 498 | 485 |
502 | Living donor transplant | 42 |
52 | 80 | Transplant outside US
| 1 | 0 | 0 |
Patient died | 35 | 33 |
30 | Patient refused transplant | 1 |
1 | 2 | Improved, transplant not needed
| 86 | 68 | 63 |
Too sick for transplant | 14 | 17 |
23 | Other | 31 |
20 | 16 |
Table LI 12 Characteristics of pediatric liver transplant recipients, 2003-2005 and 2013-2015 Liver transplant recipients, including retransplants. Pediatric candidates aged 12 to 17 years can be assigned MELD or PELD scores. HCV, hepatitis C virus.
Characteristic | 2003-05, N | 2003-05, Percent | 2013-15, N | 2013-15, Percent |
Age: < 1 year | 487 | 28.7% |
402 | 24.5% | Age: 1-5 years
| 612 | 36.1% | 662 |
40.3% | Age: 6-10 years | 227 |
13.4% | 230 | 14.0% |
Age: 11-17 years | 369 | 21.8% |
350 | 21.3% | Sex: Female
| 881 | 52.0% | 813 |
49.5% | Sex: Male | 814 |
48.0% | 831 | 50.5% |
Race/ethnicity: White | 943 | 55.6% |
858 | 52.2% | Race/ethnicity: Black
| 278 | 16.4% | 241 |
14.7% | Race/ethnicity: Hispanic | 348 |
20.5% | 383 | 23.3% |
Race/ethnicity: Asian | 82 | 4.8% |
109 | 6.6% |
Race/ethnicity: Other/unknown | 44 | 2.6% |
53 | 3.2% |
Diagnosis: Acute liver failure | 214 | 12.6% |
175 | 10.6% | Diagnosis: HCV
| 9 | 0.5% | 3 |
0.2% | Diagnosis: Alcoholic liver disease
| 0 | 0.0% | 2 |
0.1% | Diagnosis: Cholestatic disease
| 742 | 43.8% | 734 |
44.6% | Diagnosis: Malignancy | 244 |
14.4% | 221 | 13.4% |
Diagnosis: Other/unknown | 486 | 28.7% |
509 | 31.0% | Transplant history: First
| 1490 | 87.9% | 1502 |
91.4% | Transplant history: Retransplant
| 205 | 12.1% | 142 |
8.6% | Blood type: A | 590 |
34.8% | 557 | 33.9% |
Blood type: B | 210 | 12.4% |
215 | 13.1% | Blood type: AB
| 66 | 3.9% | 72 |
4.4% | Blood type: O | 829 |
48.9% | 800 | 48.7% |
Insurance: Private | 856 | 50.5% |
655 | 39.8% | Insurance: Medicare
| 30 | 1.8% | 13 |
0.8% | Insurance: Medicaid | 661 |
39.0% | 765 | 46.5% |
Insurance: Other government | 100 | 5.9% |
132 | 8.0% | Insurance: Unknown
| 48 | 2.8% | 79 |
4.8% | Wait time: < 31 days | 665 |
39.2% | 555 | 33.8% |
Wait time: 31-60 days | 238 | 14.0% |
256 | 15.6% | Wait time: 61-90 days
| 160 | 9.4% | 166 |
10.1% | Wait time: 3-< 6 months | 273 |
16.1% | 295 | 17.9% |
Wait time: 6-< 12 months | 184 | 10.9% |
193 | 11.7% | Wait time: 1-< 2 years
| 94 | 5.5% | 110 |
6.7% | Wait time: 2-< 3 years | 23 |
1.4% | 33 | 2.0% |
Wait time: ≥ 3 years | 51 | 3.0% |
36 | 2.2% | Wait time: Unknown
| 7 | 0.4% | 0 |
0.0% | Medical condition: Hospitalized in ICU
| 491 | 29.0% | 340 |
20.7% | Medical condition: Hospitalized, not ICU
| 294 | 17.3% | 270 |
16.4% | Medical condition: Not hospitalized
| 910 | 53.7% | 1024 |
62.3% | Medical condition: Hospitalization unkno
| 0 | 0.0% | 10 |
0.6% | Medical urgency: Status 1A/1B
| 668 | 39.4% | 590 |
35.9% | Medical urgency: MELD/PELD ≥ 35
| 153 | 9.0% | 324 |
19.7% | Medical urgency: MELD/PELD 30-34
| 111 | 6.5% | 193 |
11.7% | Medical urgency: MELD/PELD 15-29
| 403 | 23.8% | 367 |
22.3% | Medical urgency: MELD/PELD < 15
| 352 | 20.8% | 169 |
10.3% | Medical urgency: Unknown | 8 |
0.5% | 1 | 0.1% |
Any MELD/PELD exception | 375 | 22.1% |
636 | 38.7% | Procedure: Whole liver
| 1092 | 64.4% | 1051 |
63.9% | Procedure: Partial liver | 342 |
20.2% | 351 | 21.4% |
Procedure: Split liver | 261 | 15.4% |
242 | 14.7% | Donor type: Deceased
| 1518 | 89.6% | 1472 |
89.5% | Donor type: Living | 177 |
10.4% | 172 | 10.5% |
Previous abdomincal surgery | 900 | 53.1% |
846 | 51.5% | ABO: Compatible/identical
| 1666 | 98.3% | 1572 |
95.6% | ABO: Incompatible | 29 |
1.7% | 72 | 4.4% |
All recipients | 1695 | 100.0% |
1644 | 100.0% |
|