Liver transplantation in the United States: results from the National Pitt-UNOS Liver Transplant Registry. United Network for Organ Sharing.
The growth in liver transplantations recorded by the Pitt-UNOS Liver Transplant Registry since October 1987 continues, and in 1993 the rate of increase was greater than it had been in recent years. This is in spite of the fact that the net growth of new centers was smaller in 1993 than in any previous year examined. Pediatric recipients in 1993 were compared with those in previous years, and no significant differences were found for sex, race, or age. In contrast to prior years, the majority of pediatric recipients in 1993 awaited transplantation at home. The most common indication for liver transplantation in children was biliary atresia, although the proportion of recipients with this primary liver disease decreased slightly in 1993. Significant increases were noted in the proportions of pediatric recipients with fulminant liver failure, and hepatoblastoma. Significantly fewer children received ABO-incompatible livers in 1993 compared with prior years, part of which may be a function of the increasing use of living-related donors. Many of the characteristics examined for adult recipients had different distributions in 1993 than in prior years. The proportion of White recipients declined in 1993, due to increases among Black and Hispanic recipients. The mean and median ages of adult recipients continued to increase because of the increasing proportion of recipients aged 60 and over. The proportion of adult recipients awaiting transplantation outside of the hospital continued to increase in 1993. The increase in the proportion of recipients with positive CMV serology is likely due to the increasing age of the recipients in 1993. A smaller proportion of multiorgan transplantations was performed in 1993, due to the elimination of procedures involving only the liver and pancreas. Alcoholic cirrhosis was replaced by hepatitis non-A, non-B, or C as the most common reason for LTX. The proportions of recipients with fulminant liver failure and malignancies, indications for poorest survival, declined significantly in 1993. The cumulative probability of surviving for 6 years after initial transplantation was 0.70 (without retransplantation = 0.58) for pediatric recipients.(ABSTRACT TRUNCATED AT 400 WORDS)
Belle
S H
SH
Department of Epidemiology University of Pittsburgh, Pennsylvania, USA.
Beringer
K C
KC
Detre
K M
KM
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006648:Histocompatibility; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000453:epidemiology / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology