Recent findings concerning liver transplantation in the United States.

CENTERS

The growth in liver transplantation activity recorded by the Pitt-UNOS Liver Transplant Registry since October 1987 continued. However, for the first time since the establishment of the LTR, there was no net gain in the number of centers in 1995. The large differences in volume per center also diminished.

PATIENTS

The age of pediatric recipients increased significantly in 1995, due to a decrease in the proportion of recipients under age one. For the first time, in 1995 fewer than half of transplantations in children were for biliary atresia. The addition of bone marrow transplantations, for which collection began in 1994, accounted for half of the multi-organ transplantations in 1995. Many of the characteristics examined for adult recipients changed between 1994 and 1995. The proportion of Hispanic recipients increased. The mean age of adult recipients continued to increase, but there was not a significant change in the prevalence of positive CMV serology. Reversing a trend, the proportion of adult recipients awaiting transplantation outside of the hospital decreased between 1994 and 1995. As with children, the proportion of adult multi-organ transplantations which included bone marrow increased. Hepatitis non-A, non-B, or C and alcoholic liver disease (ALD) were the most common reasons for LTX in 1995. While the proportion of recipients with ALD alone decreased slightly, the proportion with ALD and hepatitis C increased from 1994 to 1995.

OUTCOME

The cumulative probability of surviving (without retransplantation) for 8 years after initial transplantation was .71 (.60) for pediatric recipients. The one-year survival for pediatric recipients changed significantly over time with the increase from 1994 to 1995 being similar to the increase between 1994 and prior years. Independent risk factors for survival among children included age, race, location awaiting transplantation, primary liver disease, and serum creatinine. Year of transplantation and bilirubin were independently associated with retransplantation-free survival, whereas multi-organ transplantation was associated with poorer patient survival. The cumulative probability of adults surviving (without retransplantation) for 7 years following LTX was .58 (.50). Independent risk factors were year of transplantation, age, location awaiting transplantation, primary liver disease, albumin, creatinine, and ABO match. Black recipients had poorer patient survival rates than other recipients whereas increased prothrombin time and CMV-positive donors were risk factors for retransplantation or death.