Liver transplantation epidemiology and demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Liver trasnsplantation Microchapters
Home
Patient Information
Overview
Historical Perspective
Indications
Pre-surgical management
Choice of donor
Epidemiology and Demographics
Techniques
Complications
Acute rejection
Immune therapy
Post-surgical infection
Prognosis

Overview

Incidence

• Acoording to United Network for Organ Sharing, 2753 adult LDLT and 1283 pediatric LDLT had been performed in the USA till February 2010.
• The most common indication for transplantation was primary sclerosing cholangitis (37.7%).

Survival rates

• Survival rates at 10 years was 70% for LDLT and 64% for DDLT.
• For all recipients female gender and primary sclerosing cholangitis were associated with improved survival while dialysis and older recipient/donor age were associated with worse survival.
• LDLT recipients had longer total operative time and shorter total ischemia time median 98 minutes vs 487 minutes, than DDLT recipients.
• Intraoperative blood transfusion requirements were lower in LDLT compared to DDLT. 
• Smaller graft size has higher technical complexity, the graft and patient survival rates of patients with right-liverLDLT are not different from those of patients receiving whole-graft DDLT.
• Critically ill adult recipients with advanced liver failure, high MELD scores, and numerous secondary complications have generally been reported to have worse outcomes with this procedure.

Morbidity and mortality

• Seven donor deaths have been reported till 2010 in the USA and 19 deaths worldwide.
• The overall mortality rate of liver transplantation is of the order of 0.2–0.5%.
• The risk associated with left-lobe donation may be lower than that with right-lobe donation.
• The incidence of complications in the donor varies in the literature from 9 to 67%, but is likely in the 30% range.
• The Adult Living Donor Liver Transplantation Cohort Study reported a donor complication rate of 38%; 21% of donors had one complication and 17% had two or more.

Complications

Common complications include:

• Biliary leaks beyond postoperative day 7 (9%)
• bacterial infections (12%)
• incisional hernia (6%)
• pleural effusion requiring intervention (5%)
• neuropraxia (4%)
• reexploration (3%)
• wound infections (3%)
• Intraabdominal abscess (2%)