The outcomes of adult liver transplants in the United States from 1987 to 2013

Background & Aims: 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. Conclusion: 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 infection rates improved substantially, post-discharge mortality remains stable because of increasing losses to competing risks in patients with non-liver comorbidities.