title: The outcomes of adult liver transplants in the United States from 1987 to 2013.
abstract: OBJECTIVE
  In the past three decades, there have been major advances in the procedure and candidate selection for liver transplantation. The aim of this study was to assess the changes in outcomes of liver transplantations in the Unites States.
  
  
  METHODS
  This observational study uses the Scientific Registry of Transplant Recipients (SRTR) that includes all liver transplants from 1987 to 2013 (N = 108 707 adults).
  
  
  RESULTS
  Four study cycles were introduced: 1987-1993, 1994-2000, 2001-2006, 2007-2013. The length of inpatient stay for receiving liver transplant substantially shortened (42-20 days), and so did the rate of acute post-transplant rejections (33-4%). The use of high risk donors and donors with chronic diseases increased significantly. Of transplant outcomes, despite recently reported unfavourable changes in clinico-demographic profile of liver transplant recipients (older age, substantial increases in all major comorbidities), the proportion of patients discharged alive increased from 78.2 to 91.8%. On the other hand, post-discharge 1-, 3- and 5-year mortality varied between 6.7 and 8.0%, 15.2 to 17.2% and 22.5 to 24.5%, respectively, and no consistent trend was found. Despite this, the rates of graft failure decreased: an approximately two-fold decrease in 1 year graft loss, and a 1.6-fold decrease in 5 year graft loss were observed.
  
  
  CONCLUSIONS
  Despite all improvements in liver transplant technique and patient management, the changes in post-transplant outcomes vary. While inpatient mortality, graft losses and post-transplant infect-ion rates improved substantially, post-discharge mortality remains stable because of increasing losses to competing risks in patients with non-liver comorbidities.
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.|Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Stepanova
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Homan
authors.initials: H
authors.lastname: Wai
authors.affiliation: Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.|Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: Alita
authors.initials: A
authors.lastname: Mishra
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.|Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: Chapy
authors.initials: C
authors.lastname: Venkatesan
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.|Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality* / Q000706:statistics & numerical data; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
keywords: cirrhosis; liver cancer; liver transplantation; outcomes