An analysis of the OPTN/UNOS Liver Transplant Registry.

This chapter summarizes analyses of 51,060 adult primary liver-only transplants from deceased donors reported to the OPTN/UNOS Liver Transplant Registry from 1995 to 2009. Despite advances in surgical techniques and immunosuppression, analysis shows improvement in one-year graft but no improvement in long-term graft survival. Adoption of the Model for End-Stage Liver Disease (MELD) score for organ allocation--prioritizing sicker patients for transplantation--has significantly influenced liver transplant procedures. Accordingly, we classified the transplants into two groups: 1995-2001 (pre-MELD era) and 2002-2007 (MELD era), and our analyses found that long-term survival of liver grafts remained almost unchanged between the two eras. Patient pre-transplant status was better in the MELD era. But when we analyzed the grafts that survived more than one year, survival rates were slightly better pre-MELD than in the MELD era (82.2% and 80.34%, respectively) and risk of graft failure was slightly higher in the MELD era. This chapter also provides analyses of current graft survival rates for 10 different primary liver diseases. Hepatocellular carcinoma, hepatitis C virus cirrhosis, and alcoholic liver disease account for almost 50 % of the primary diseases, and have worse graft survival than the other primary diseases. The lack of improvement in long-term survival suggests an on-going need for means to avoid chronic liver graft dysfunction and to develop therapeutic interventions to control chronic graft loss.