OPTN/SRTR 2011 Annual Data Report: Liver

Abstract

The current liver allocation system, introduced in 2002, decreased the importance of waiting time for allocation priorities; the number of active wait‐listed candidates and median waiting times were immediately reduced. However, the total number of adult wait‐listed candidates has increased since 2002, and median waiting time has increased since 2006. Pretransplant mortality rates have been stable, but the number of candidates withdrawn from the list as being too sick to undergo transplant nearly doubled between 2009 and 2011. Deceased donation rates have remained stable, with an increasing proportion of expanded criteria donors. Living donation has decreased over the past 10 years. Transplant outcomes remain robust, with continuously improving graft survival rates for deceased donor, living donor, and donation after circulatory death livers. Numbers of new and prevalent pediatric candidates on the waiting list have decreased. Pediatric pretransplant mortality has decreased, most dramatically for candidates aged less than 1 year. The transplant rate has increased since 2002, and is highest in candidates aged less than 1 year. Graft survival continues to improve for pediatric recipients of deceased donor and living donor livers. Incidence of acute rejections increases with time after transplant. Posttransplant lymphoproliferative disorder remains an important concern in pediatric recipients.

Current Management of Hepatitis C Virus

“…3 Given this burden of disease, is it not surprising that HCV infection remains the most common indication for liver transplant (LT) in the United States. 4 Recurrence of HCV after LT is universal in viremic patients undergoing LT; in adjusted models, recurrent HCV leads to an approximately 28% (95% confidence interval [CI]: 15%-40%) increase in graft loss and a 17% (95% CI: 3%-32%) increase in recipient mortality compared with LT recipients without HCV. 5 The natural history of recurrent HCV is significantly more aggressive compared with the natural history before LT, with 20% to 54% developing bridging fibrosis/cirrhosis at 5 years 6 and 2% to 9% developing the aggressive and rapidly progressive fibrosing cholestatic HCV within 1 year after LT. 7 On the other hand, successful HCV eradication either before LT or after LT has been shown to improve post-LT outcomes 8 and, therefore, is the goal of HCV treatment in the peri-LT setting.…”

Model for end-stage liver disease score and MELD exceptions: 15 years later

“…According to the latest annual report of the Scientific Registry of Transplant Recipients (SRTR), compared with 2002, candidates on the waiting list in 2012 have a higher MELD score at transplant (mean MELD [ 30, 34 vs. 14.6 %), are older (age [ 65 years, 14.6 vs. 7.6 %), and have more co-morbidities, for example obesity (32 vs. 26 %), portal vein thrombosis (9.9 vs. 2.8 %), previous abdominal surgery (43 vs. 36 %), and spontaneous bacterial peritonitis (9.1 vs. 7.3 %). [49] Despite this, patient survival within the first 2-3 years did not differ from that in the pre MELD era [50,51]. Management of patients on the waiting list is becoming more difficult.…”

“…Although the number of patients with renal dysfunction at the time of LT increased (26.1 % in 2002 to 29.8 % in 2008) [16] implementation of the MELD allocation system was not associated with increased mortality or the occurrence of stage 3 of 4 chronic kidney disease in the first two years after LT [57,58]. However, the number of persons needing simultaneous liver and kidney transplants has dramatically increased from 2 to 8 % over the last decade [49]. The risk of long-term posttransplant end-stage renal disease, a significant predictor of post-transplant mortality, was 15 % higher in the MELD era.…”

Acute liver failure and transplantation in children

“…[3] Over a 3year period, from 2009 to 2011, there were 241 (14.4%) liver transplants in children listed at status 1A in the USA; this number also includes those who required emergency retransplantation for hepatic artery thrombosis and primary nonfunction. [7] Outcomes of liver transplantation for ALF have generally shown poorer survival than for chronic liver failure. In the early SPLIT experience from 1995 to 2002, there was a 74% 1year patient survival rate for ALF compared with 88.2% for all other causes.…”