A report from the NIDDK Liver Transplantation Database.

The development and pilot phase of the NIDDK LTD project has been successfully completed by recruiting and uniformly evaluating at baseline and follow-up of 176 candidates and 101 transplant patients from 5 LTD Clinical Centers (Baylor University Medical Center, Mayo Clinic, University of California at Los Angeles, University of Minnesota, and University of Pittsburgh). The first set of analyses presented in this report describes the characteristics of the candidates, recipients and donors who were enrolled in the LTD pilot study. Other findings must be regarded as trends until more data become available. Candidates who presented with fulminant or subacute liver failure as well as those with lupoid type chronic active hepatitis had the highest selection rate for transplantation while those with malignancy and alcoholic cirrhosis had the lowest. Overall, little selection occurred on the basis of age alone. Early posttransplantation recovery characterized by prolonged ICU stay, or by death or retransplantation in the ICU, were significantly influenced by operative and recipient factors. Generally, when function of other organ systems was impaired, the event rates were higher. Abnormal neurological status represented the greatest risk. For the ICU course, patients with fulminant disease fared the worst and cirrhotics the best. Long operation (greater than 8 hrs) and blood use in excess of 3,000 ml had 2-3 times the risk for long ICU stay or adverse ICU events. Surprisingly, donor and harvesting factors also played a significant role in the early posttransplantation course. Such trends were shown for drug abuser donors and for rapid hepatectomy time. The harvesting surgeon's assessment of the donor and the graft had good predictive value of the ICU course. Finally, patients who required retransplantation within 6 weeks more often had donors with histories of longer hospitalization and fewer grafts that were deemed excellent or good at harvest.