Abstract
Data on adult liver transplants performed in the US in 2018 are notable for (1) continued growth in numbers of new waitlist registrants (11,844) and transplants performed (8250); (2) continued increase in the transplant rate (54.5 per 100 waitlist-years); (3) a precipitous decline in waitlist registrations and transplants for hepatitis-C-related indications; (4) increases in waitlist registrants and recipients with alcoholic liver disease and with clinical profiles consistent with non-alcoholic fatty liver disease; (5) increased use of hepatitis C virus antibody-positive donor livers; and (6) continued improvement in graft survival despite changing recipient characteristics such as older age and higher rates of obesity and diabetes. Variability in transplant rates remained by candidate race, hepatocellular carcinoma status, urgency status, and geography. The volume of pediatric liver transplants was relatively unchanged. The highest rate of pre-transplant mortality persisted for children aged younger than 1 year. Children underwent transplant at higher acuity than in the past, as evidenced by higher model for end-stage liver disease/pediatric end-stage liver disease scores and listings at status 1A and 1B at transplant. Despite higher illness severity scores at transplant, pediatric graft and patient survival posttransplant have improved over time.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 193-299 |
| Number of pages | 107 |
| Journal | American Journal of Transplantation |
| Volume | 20 |
| Issue number | s1 |
| DOIs | |
| State | Published - Jan 1 2020 |
Bibliographical note
Funding Information:Figure LI 122 Figure LI 123 In 2018, 56.2% of pediatric liver transplant recipients received no induction therapy, 30.1% received interleukin‐2 receptor antagonists, and 14.0% received a T‐cell depleting agent ( ). The most commonly used initial immunosuppression regimens were tacrolimus and steroids (42.2%) and tacrolimus, mycophenolate mofetil, and steroids (35.3%) ( ). LI 122 Induction agent use in pediatric liver transplant recipients. Immunosuppression at transplant reported to the OPTN . IL 2‐ RA , interleukin‐2 receptor antagonist. LI 123 Immunosuppression regimen use in pediatric liver transplant recipients. Immunosuppression regimen at transplant reported to the OPTN . Tac, tacrolimus. MMF , mycophenolate mofetil. Figure LI 125 Figure LI 126 Figure LI 127 Graft survival continued to improve over the past decade among pediatric recipients of deceased donor and living donor livers. Graft failure occurred in 6.6% at 6 months and in 7.0% at 1 year among deceased donor liver transplants performed in 2017, in 12.4% at 3 years for transplants performed in 2015, in 18.5% at 5 years for transplants performed in 2013, and in 26.9% at 10 years for transplants performed in 2008 ( ). Graft failure occurred in 4.5% of recipients at 6 months and in 6.0% at 1 year posttransplant among living donor transplants performed in 2016‐2017, in 7.6% at 3 years for transplants performed in 2014‐2015, in 11.8% at 5 years for transplants performed in 2012‐2013, and in 15.6% at 10 years for transplants performed in 2008‐2009 ( ). By age, 5‐year graft survival was 80.3% for recipients aged younger than 1 year, 80.5% for ages 1‐5 years, 87.3% for ages 6‐10 years, and 82.7% for ages 11‐17 years ( ). Five‐year graft survival was 83.9% for recipients who underwent transplant with MELD/PELD Figure LI 129 Figure LI 130 Figure LI 131 Figure LI 132 Figure LI 133 Figure LI 134 Figure LI 135 Figure LI 136 Figure LI 137 Figure LI 137 < 15, compared with approximately 79% for recipients who underwent transplant as status 1A/1B ( ). Five‐year graft survival was 83.2% for recipients of a first liver transplant, compared with 69.6% for re‐transplant recipients ( ). In 2016‐2017, incidence of acute rejection by 1 year posttransplant was 23.1% overall, varying from 26.1% in recipients aged 1‐5 years to 17.8% in those aged 6‐10 years ( ). Regarding use of induction agents and acute rejection, rates ranged from 18.4% among recipients who received interleukin‐2 receptor antagonists to 25.3% among those who did not report induction therapy ( ). Incidence of posttransplant lymphoproliferative disorder was 4.6% at 5 years posttransplant for recipients who were EBV negative and 2.7% for those who were positive ( ). Among pediatric liver transplants 2009‐2013, overall 5‐year patient survival was 88.4%, varying from 87.2% for recipients aged 1‐5 years to 92.2% for those aged 6‐10 years ( ). By primary diagnosis, metabolic disease and cholestatic biliary atresia were associated with superior patient survival ( ). Of deceased donor transplant recipients in 2012‐2017, 5.8% died within 1 year of transplant with cardio/cerebrovascular complications as the leading cause of death ( ). Of deceased donor transplant recipients in 2011‐2013, 9.8% died within 5 years of transplant ( ). The leading causes of death were graft failure (1.5%) and cardio/cerebrovascular complications (1.1%) ( ). LI 124 Total HL A A, B, and DR mismatches among pediatric deceased donor liver‐kidney transplant recipients, 2014‐2018. Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2018. Limited to deceased donor liver‐kidney transplants only. LI 125 Graft failure among pediatric deceased donor liver transplant recipients. All pediatric recipients of deceased donor livers, including multi‐organ transplants. Patients are followed until the earliest of retransplant, death, or December 31, 2018. LI 126 Graft failure among pediatric living donor liver transplant recipients. All pediatric recipients of living donor livers, including multi‐organ transplants. Patients are followed until the earliest of retransplant, death, or December 31, 2018. LI 127 Graft survival among pediatric deceased donor liver transplant recipients, 2009‐2013, by age. Graft survival estimated using unadjusted Kaplan‐Meier methods. LI 128 Graft survival among pediatric deceased donor liver transplant recipients, 2009‐2013, by diagnosis. Graft survival estimated using unadjusted Kaplan‐Meier methods. Chol. disease, cholestatic disease. LI 129 Graft survival among pediatric deceased donor liver transplant recipients, 2009‐2013, by medical urgency. Graft survival estimated using unadjusted Kaplan‐Meier methods. Pediatric candidates aged 12 to 17 years can be assigned MELD or PELD scores. LI 130 Graft survival among pediatric deceased donor liver transplant recipients, 2009‐2013, by retransplant. Graft survival estimated using unadjusted Kaplan‐Meier methods. LI 131 Incidence of acute rejection by 1 year posttransplant among pediatric liver transplant recipients by age, 2016‐2017. Acute rejection is defined as a record of acute or hyperacute rejection, as reported on the OPTN Transplant Recipient Registration Form or Transplant Recipient Followup Form. Only the first rejection event is counted. Cumulative incidence is estimated using the Kaplan‐Meier competing risk method. LI 132 Incidence of acute rejection by 1 year posttransplant among pediatric liver transplant recipients by induction agent 2016‐2017. Acute rejection is defined as a record of acute or hyperacute rejection, as reported on the OPTN Transplant Recipient Registration or Transplant Recipient Follow‐up Form. Only the first rejection event is counted. Cumulative incidence is estimated using the Kaplan‐Meier competing risk method. If a recipient used both IL ‐2‐ RA and TCD agents, s/he will contribute to both of those cumulative incidence estimates. LI 133 Incidence of PTLD among pediatric liver transplant recipients by recipient EBV status at transplant, 2006‐2016. Cumulative incidence is estimated using the Kaplan‐Meier competing risk method. Posttrans‐plant lymphoproliferative disorder ( PTLD ) is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow‐up Form or on the Posttransplant Malignancy Form as polymorphic PTLD , monomorphic PTLD , or Hodgkin's disease. Only the earliest date of PTLD diagnosis is considered. EBV , Epstein‐Barr virus. LI 134 Patient survival among pediatric deceased donor liver transplant recipients, 2009‐2013, by age. Recipient survival estimated using unadjusted Kaplan‐Meier methods. LI 135 Patient survival among pediatric deceased donor liver transplant recipients, 2009‐2013, by diagnosis. Recipient survival estimated using unadjusted Kaplan‐Meier methods. Chol. disease, cholestatic disease. LI 136 One‐year cumulative incidence of death by cause among pediatric liver recipients, 2012‐2017. Primary cause of death is as reported on the OPTN Transplant Recipient Registration and Follow‐up Forms. Other causes of death include hemorrhage, trauma, nonadherence, unspecified other, unknown, etc. Cumulative incidence is estimated using Kaplan‐Meier competing risk methods. LI 137 Five‐year cumulative incidence of death by cause among pediatric liver recipients, 2011‐2013. Primary cause of death is as reported on the OPTN Transplant Recipient Registration and Follow‐up Forms. Other causes of death include hemorrhage, trauma, nonadherence, unspecified other, unknown, etc. Cumulative incidence is estimated using Kaplan‐Meier competing risk methods. The publication was produced for the U.S. Department of Health and Human Services, Health Resources and Services Administration, by the Hennepin Healthcare Research Institute (HHRI) and by the United Network for Organ Sharing (UNOS) under contracts HHSH250201500009C and 234‐2005‐37011C, respectively. This publication lists non‐federal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by the U.S. Department of Health and Human Services (HHS) or the Health Resources and Services Administration (HRSA). Neither HHS nor HRSA endorses the products or services of the listed resources. OPTN/SRTR 2018 Annual Data Report is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. Data are not copyrighted and may be used without permission if appropriate citation information is provided. Pursuant to 42 U.S.C. §1320b‐10, this publication may not be reproduced, reprinted, or redistributed for a fee without specific written authorization from HHS. Suggested Citations Full citation: Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2018 Annual Data Report. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration; 2019. Abbreviated citation: OPTN/SRTR 2018 Annual Data Report. HHS/HRSA. Publications based on data in this report or supplied on request must include a citation and the following statement: The data and analyses reported in the 2018 Annual Data Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients have been supplied by the United Network for Organ Sharing and the Hennepin Healthcare Research Institute under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. Government. This report is available at srtr.transplant.hrsa.gov. Individual chapters, as well as the report as a whole, may be downloaded.
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Keywords
- Liver transplant
- allocation
- distribution
- waiting list
