Trends in liver transplantation in the United States.

Although the growth in liver transplantations (LTX) recorded by the Pitt-UNOS Liver Transplant Registry since October 1987 continues, the rate of increase has been declining in recent years. Among children, the number of procedures reached a peak in 1990 and declined each year thereafter. The number of centers performing LTX continued to increase. However, in 1992, compared with previous years, the greatest proportion of centers had a decreased volume of procedures, and the fewest number of new centers were opened. Upon examining characteristics of pediatric recipients from 1987 through 1992, no significant trends were noted for sex, race, age, or nationality. The distribution of functional status in 1992 was similar to that prior to 1991. Compared with recipients in the other 2 time periods, recipients in 1991 were more likely to be in the best functional status and least likely to be in the ICU. The most common indication for LTX in children was biliary atresia, though the proportion of recipients with this primary liver disease decreased significantly over the study period. Significant increases were noted in the proportions of pediatric recipients with autoimmune disease (though this remains a relatively uncommon indication) and fulminant liver failure. There have been trends in many of the characteristics examined for adult recipients. The proportion of male recipients grew significantly between 1987 and 1992. Decreasing proportions of White recipients and increases among Hispanics and Asians were found. The mean and median ages of adult recipients peaked in 1990, with a slight decrease in 1992 reflecting a slight rise in the proportion of the youngest age group and a slight decline for the oldest age group. Adult recipients had better functional status in 1991 than earlier recipients, and the distribution in 1992 was very similar to that in 1991. The trend in the proportion of recipients with positive CMV serology followed very closely the pattern in age distribution, peaking in 1991 and dropping slightly in 1992. The proportions of multiorgan recipients were similar in all 3 time periods. However, in 1992, contrasting with previous years, most multiorgan procedures involved only a kidney. Alcoholic cirrhosis continued to be the most common reason for LTX, though the combination of non-A, non-B hepatitis and hepatitis C accounted for only 20 fewer recipients. The proportions of recipients with hepatitis B and malignancies (the indications with the poorest survival) declined significantly. The cumulative probability of patient (retransplantation-free) survival 5 years after initial transplantation was 0.7 (0.58) for pediatric recipients.(ABSTRACT TRUNCATED AT 400 WORDS)