OPTN/SRTR 2021 Annual Data Report: Liver

In 2021, liver transplant volume continued to grow, with a record 9,234 transplants performed in the United States, 8,665 (93.8%) from deceased donors and 569 (6.2%) from living donors. There were 8,733 (94.6%) adult and 501 (5.4%) pediatric liver transplant recipients. An increase in the number of...

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Published inAmerican journal of transplantation Vol. 23; no. 2; pp. S178 - S263
Main Authors Kwong, Allison J., Ebel, Noelle H., Kim, W. Ray, Lake, John R., Smith, Jodi M., Schladt, David P., Schnellinger, Erin M., Handarova, Dzhuliyana, Weiss, Samantha, Cafarella, Matthew, Snyder, Jon J., Israni, Ajay K., Kasiske, Bertram L.
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Published United States Elsevier Inc 01.02.2023
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Abstract In 2021, liver transplant volume continued to grow, with a record 9,234 transplants performed in the United States, 8,665 (93.8%) from deceased donors and 569 (6.2%) from living donors. There were 8,733 (94.6%) adult and 501 (5.4%) pediatric liver transplant recipients. An increase in the number of deceased donor livers corresponded to an increase in the overall transplant rate and shorter waiting times, although still 10.0% of livers that were recovered were not transplanted. Alcohol-associated liver disease was the leading indication for both waitlist registration and liver transplant in adults, outpacing nonalcoholic steatohepatitis, while biliary atresia remained the leading indication for children. Related to allocation policy changes implemented in 2019, the proportion of liver transplants performed for hepatocellular carcinoma has decreased. Among adult candidates listed for liver transplant in 2020, 37.7% received a deceased donor liver transplant within 3 months, 43.8% within 6 months, and 53.3% within 1 year. Pretransplant mortality improved for children following implementation of acuity circle–based distribution. Short-term graft and patient survival outcomes up to 1 year worsened for adult deceased and living donor liver transplant recipients, which is a reversal of previous trends and coincided with the onset of the COVID-19 pandemic in early 2020. Longer-term outcomes among adult deceased donor liver transplant recipients were unaffected, with overall posttransplant mortality rates of 13.3% at 3 years, 18.6% at 5 years, and 35.9% at 10 years. Pretransplant mortality improved for children following implementation of acuity circle–based distribution and prioritization of pediatric donors to pediatric recipients in 2020. Pediatric living donor recipients had superior graft and patient survival outcomes compared with deceased donor recipients at all time points. [Display omitted]
AbstractList In 2021, liver transplant volume continued to grow, with a record 9,234 transplants performed in the United States, 8,665 (93.8%) from deceased donors and 569 (6.2%) from living donors. There were 8,733 (94.6%) adult and 501 (5.4%) pediatric liver transplant recipients. An increase in the number of deceased donor livers corresponded to an increase in the overall transplant rate and shorter waiting times, although still 10.0% of livers that were recovered were not transplanted. Alcohol-associated liver disease was the leading indication for both waitlist registration and liver transplant in adults, outpacing nonalcoholic steatohepatitis, while biliary atresia remained the leading indication for children. Related to allocation policy changes implemented in 2019, the proportion of liver transplants performed for hepatocellular carcinoma has decreased. Among adult candidates listed for liver transplant in 2020, 37.7% received a deceased donor liver transplant within 3 months, 43.8% within 6 months, and 53.3% within 1 year. Pretransplant mortality improved for children following implementation of acuity circle–based distribution. Short-term graft and patient survival outcomes up to 1 year worsened for adult deceased and living donor liver transplant recipients, which is a reversal of previous trends and coincided with the onset of the COVID-19 pandemic in early 2020. Longer-term outcomes among adult deceased donor liver transplant recipients were unaffected, with overall posttransplant mortality rates of 13.3% at 3 years, 18.6% at 5 years, and 35.9% at 10 years. Pretransplant mortality improved for children following implementation of acuity circle–based distribution and prioritization of pediatric donors to pediatric recipients in 2020. Pediatric living donor recipients had superior graft and patient survival outcomes compared with deceased donor recipients at all time points. [Display omitted]
In 2021, liver transplant volume continued to grow, with a record 9,234 transplants performed in the United States, 8,665 (93.8%) from deceased donors and 569 (6.2%) from living donors. There were 8,733 (94.6%) adult and 501 (5.4%) pediatric liver transplant recipients. An increase in the number of deceased donor livers corresponded to an increase in the overall transplant rate and shorter waiting times, although still 10.0% of livers that were recovered were not transplanted. Alcohol-associated liver disease was the leading indication for both waitlist registration and liver transplant in adults, outpacing nonalcoholic steatohepatitis, while biliary atresia remained the leading indication for children. Related to allocation policy changes implemented in 2019, the proportion of liver transplants performed for hepatocellular carcinoma has decreased. Among adult candidates listed for liver transplant in 2020, 37.7% received a deceased donor liver transplant within 3 months, 43.8% within 6 months, and 53.3% within 1 year. Pretransplant mortality improved for children following implementation of acuity circle-based distribution. Short-term graft and patient survival outcomes up to 1 year worsened for adult deceased and living donor liver transplant recipients, which is a reversal of previous trends and coincided with the onset of the COVID-19 pandemic in early 2020. Longer-term outcomes among adult deceased donor liver transplant recipients were unaffected, with overall posttransplant mortality rates of 13.3% at 3 years, 18.6% at 5 years, and 35.9% at 10 years. Pretransplant mortality improved for children following implementation of acuity circle-based distribution and prioritization of pediatric donors to pediatric recipients in 2020. Pediatric living donor recipients had superior graft and patient survival outcomes compared with deceased donor recipients at all time points.
Author Schnellinger, Erin M.
Ebel, Noelle H.
Snyder, Jon J.
Kim, W. Ray
Handarova, Dzhuliyana
Smith, Jodi M.
Cafarella, Matthew
Israni, Ajay K.
Kwong, Allison J.
Schladt, David P.
Lake, John R.
Weiss, Samantha
Kasiske, Bertram L.
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  givenname: Allison J.
  surname: Kwong
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  organization: Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA
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  givenname: Noelle H.
  surname: Ebel
  fullname: Ebel, Noelle H.
  organization: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA
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  givenname: W. Ray
  surname: Kim
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  organization: Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA
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  givenname: John R.
  surname: Lake
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  organization: Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
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  givenname: Jodi M.
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  organization: Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
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  givenname: Dzhuliyana
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  fullname: Handarova, Dzhuliyana
  organization: Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
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  givenname: Samantha
  surname: Weiss
  fullname: Weiss, Samantha
  organization: Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
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  fullname: Cafarella, Matthew
  organization: Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
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  organization: Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
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  givenname: Ajay K.
  surname: Israni
  fullname: Israni, Ajay K.
  organization: Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
– sequence: 13
  givenname: Bertram L.
  surname: Kasiske
  fullname: Kasiske, Bertram L.
  organization: Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
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Issue 2
Keywords Liver transplant
allocation
distribution
waiting list
Language English
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Copyright © 2023. Published by Elsevier Inc.
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Snippet In 2021, liver transplant volume continued to grow, with a record 9,234 transplants performed in the United States, 8,665 (93.8%) from deceased donors and 569...
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SubjectTerms Adult
allocation
Child
COVID-19 - epidemiology
distribution
Graft Survival
Humans
Liver Diseases, Alcoholic
Liver Neoplasms
Liver transplant
Liver Transplantation
Living Donors
Pandemics
Tissue and Organ Procurement
Tissue Donors
United States - epidemiology
waiting list
Waiting Lists
Title OPTN/SRTR 2021 Annual Data Report: Liver
URI https://dx.doi.org/10.1016/j.ajt.2023.02.006
https://www.ncbi.nlm.nih.gov/pubmed/37132348
https://search.proquest.com/docview/2809005626
Volume 23
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