Liver Transplantation in the United States, 1999-2008

TLDR

The study aims to provide a general summary and a detailed analysis of liver transplantation for hepatitis C, retransplantation, and simultaneous liver‑kidney transplantation in the United States from 1999 to 2008. The authors analyzed SRTR data to assess the status of liver transplantation during that period. Policy changes in 2002 reduced the waiting list and altered recipient profiles, leading to a peak in transplants in 2006, increased donor age, higher MELD exceptions, more hepatocellular carcinoma cases, and greater prevalence of obesity, diabetes, and renal insufficiency, while decreasing retransplantation and living donor or DCD grafts, yet overall 1‑year graft and patient survival improved from 1998 to 2007, though significant regional disparities in wait times and post‑transplant outcomes remained.

Abstract

Changes in organ allocation policy in 2002 reduced the number of adult patients on the liver transplant waiting list, changed the characteristics of transplant recipients and increased the number of patients receiving simultaneous liver-kidney transplantation (SLK). The number of liver transplants peaked in 2006 and declined marginally in 2007 and 2008. During this period, there was an increase in donor age, the Donor Risk Index, the number of candidates receiving MELD exception scores and the number of recipients with hepatocellular carcinoma. In contrast, there was a decrease in retransplantation rates, and the number of patients receiving grafts from either a living donor or from donation after cardiac death. The proportion of patients with severe obesity, diabetes and renal insufficiency increased during this period. Despite increases in donor and recipient risk factors, there was a trend towards better 1-year graft and patient survival between 1998 and 2007. Of major concern, however, were considerable regional variations in waiting time and posttransplant survival. The current status of liver transplantation in the United States between 1999 and 2008 was analyzed using SRTR data. In addition to a general summary, we have included a more detailed analysis of liver transplantation for hepatitis C, retransplantation and SLK transplantation.