The Pitt-UNOS Liver Transplant Registry.
Since the establishment of the scientific LTR, the frequency of OLTX has been increasing. Between 1988 and 1991, the number of procedures performed on pediatric patients increased by 28.2%, and among adult patients OLTX increased 84.8%. During this same period, the number of transplant centers performing OLTX rose 62.5% for children, and 54.7% for adult recipients. In 1991 there was a larger proportion of recipients under 1 year of age than in previous years. The effect was to lower the median age at transplantation from over 2 to between 1 and 2. In pediatric recipients of initial transplantation in 1991, compared with earlier recipients, the functional status at time of liver transplantation was improved. Fewer children were in the ICU while awaiting transplantation, and more were able to wait at home. Multiorgan transplantations in pediatric patients remained relatively rare, but a larger portion of these procedures in 1991 than was seen previously included the small intestine. Biliary atresia remained the most common indication for liver transplantation among children, accounting for over 55% of all OLTX procedures in 1991. There was a significant change in the racial distribution among adult recipients. Compared with previous years, there were greater proportions of Hispanic and Asian recipients in 1991. Adult recipients were older in 1991 than previously, and the median age increased from 46 to 49. As with pediatric recipients, adult recipients had better functional status in 1991 than earlier recipients. The increase in positive CMV serology was likely to be a function of older age. Among multiorgan recipients, the combination of liver and pancreas only was much less common in 1991 than previously. As was found previously (1), alcoholic cirrhosis continued to be the most common reason for OLTX, with the proportion of patients diagnosed with this condition increasing in 1991. Twice as many patients with cystic fibrosis were recipients in 1991 as in the prior 3 years. There were decreases in the proportion of patients receiving OLTX due to fulminant liver failure, metabolic disease, and malignant neoplasms. The cumulative probability of surviving (without retransplantation) 4 years after initial transplantation was 0.74 (0.61) for pediatric recipients. Univariate (unadjusted) analyses detected significant differences in survival for age (the youngest recipients had the worst survival), UNOS description (poorer functional status just prior to transplantation led to poorer survival), and primary liver disease (survival was worst for recipients transplanted due to fulminant liver failure, and best for patients with alpha-1 antitrypsin deficiency).(ABSTRACT TRUNCATED AT 400 WORDS)
Belle
S H
SH
Department of Epidemiology, University of Pittsburgh, Pennsylvania.
Beringer
K C
KC
Murphy
J B
JB
Detre
K M
KM
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D044469:Racial Groups; D012042:Registries; D015996:Survival Rate; D014481:United States / Q000453:epidemiology