Trends of characteristics and outcomes of donors and recipients of deceased donor liver transplantation in the United States: 1990 to 2013

doi:10.5500/wjt.v8.i5.167

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World Journal of Transplantation

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Transplantation. Sep 10, 2018; 8(5): 167-177
Published online Sep 10, 2018. doi: 10.5500/wjt.v8.i5.167

Table 1 Donor characteristics n (%)

Donor characteristics	Total	5 yr periods				P-value¹
		Period 1	Period 2	Period 3	Period 4
		1990-1994	1995-1999	2000-2004	2005-2009
Age, mean (SD)	39.1 (17.4)	32.3 (15.2)	37.0 (17.4)	40.6 (17.6)	42.4 (17.2)	< 0.001
Gender						< 0.001
Female	27884 (39.6)	3831 (35.4)	6397 (40.1)	8077 (41.0)	9579 (40.1)
Male	42492 (60.4)	6998 (64.6)	9573 (59.9)	11625 (59.0)	14296 (59.9)
BMI, mean (SD)	25.9 (5.7)	23.8 (4.6)	24.8 (5.2)	26.0 (5.6)	27.0 (6.0)	< 0.001
BMI						< 0.001
Underweight	3310 (4.7)	502 (4.6)	1077 (6.7)	910 (4.6)	821 (3.4)
Normal	29093 (41.3)	3655 (33.8)	7698 (48.2)	8730 (44.3)	9010 (37.7)
Overweight	20441 (29.1)	1582 (14.6)	4461 (27.9)	6345 (32.2)	8053 (33.7)
Obese - Class I	7921 (11.3)	384 (3.6)	1369 (8.6)	2459 (12.5)	3709 (15.5)
Obese - Class II	2722 (3.9)	84 (0.8)	367 (2.3)	801 (4.1)	1470 (6.2)
Obese - Class III	1496 (2.1)	47 (0.4)	196 (1.2)	446 (2.3)	807 (3.4)
Unknown	5394 (7.7)	4575 (42.3)	802 (5.0)	12 (0.1)	5 (0.0)
Ethnicity						< 0.001
White	51594 (73.3)	8747 (80.8)	12334 (77.2)	14444 (73.3)	16069 (67.3)
Black	9195 (13.1)	1044 (9.6)	1741 (10.9)	2481 (12.6)	3929 (16.5)
Hispanic	7460 (10.6)	812 (7.5)	1396 (8.7)	2144 (10.9)	3108 (13.0)
Asian	1327 (1.9)	135 (1.3)	255 (1.6)	395 (2.0)	542 (2.3)
Other	662 (0.9)	47 (0.4)	164 (1.0)	224 (1.1)	227 (1.0)
Unknown	139 (0.2)	44 (0.4)	80 (0.5)	15 (0.1)
Causes of death						< 0.001
Anoxia	7848 (11.2)	483 (4.5)	1256 (7.9)	2028 (10.3)	4081 (17.1)
Cerebrovascular/stroke	29788 (42.3)	3778 (34.9)	6645 (41.6)	8929 (45.3)	10436 (43.7)
Head trauma	28087 (39.9)	3576 (33.0)	7592 (47.5)	8171 (41.5)	8748 (36.6)

¹Contrast between period 1 and 4. CNS: Central nervous system; SD: Standard deviation; BMI: Body mass index.

Table 2 Recipient characteristics n (%)

Recipient characteristics	Total	5 yr periods				P-value¹
		Period 1	Period 2	Period 3	Period 4
		1990-1994	1995-1999	2000-2004	2005-2009
Age, mean (SD)	51.3 (10.5)	48.2 (11.4)	49.8 (10.5)	51.5 (9.7)	53.5 (9.9)	< 0.001
Gender						< 0.001
Female	25073 (35.6)	4724 (43.6)	6272 (39.3)	6544 (33.2)	7533 (31.6)
Male	45304 (64.4)	6105 (56.4)	9698 (60.7)	13159 (66.8)	16342 (68.5)
BMI, mean (SD)	27.75 (5.6)	26.26 (5.3)	27.47 (5.6)	28.03 (5.6)	28.35 (5.6)	< 0.001
BMI						< 0.001
Underweight	1458 (2.1)	371 (3.4)	319 (2.0)	364 (1.9)	404 (1.7)
Normal	22533 (32.0)	4580 (42.3)	5395 (33.8)	5868 (29.8)	6690 (28.0)
Overweight	24550 (34.9)	3436 (31.7)	5494 (34.4)	7077 (35.9)	8543 (35.8)
Obese - Class I	13417 (19.1)	1488 (13.7)	2771 (17.4)	3991 (20.3)	5167 (21.6)
Obese - Class II	5583 (7.9)	527 (4.9)	1166 (7.3)	1623 (8.2)	2267 (9.5)
Obese - Class III	2084 (3.0)	203 (1.9)	452 (2.8)	629 (3.2)	800 (3.4)
Unknown	752 (1.1)	224 (2.1)	373 (2.3)	151 (0.8)	4 (0.0)
Ethnicity						< 0.001
White	53474 (76.0)	8839 (81.6)	12501 (78.3)	14844 (75.3)	17290 (72.4)
Black	5448 (7.7)	631 (5.8)	1097 (6.9)	1565 (7.9)	2155 (9.0)
Hispanic	7907 (11.2)	901 (8.3)	1655 (10.4)	2294 (11.6)	3057 (12.8)
Asian	2785 (4.0)	317 (2.9)	555 (3.5)	785 (4.0)	1128 (4.7)
Other	719 (1.0)	99 (0.9)	160 (1.0)	215 (1.1)	245 (1.0)
Unknown	44 (0.1)	42 (0.4)	2 (0.0)
Highest education level						0.2
Unknown	26282 (37.3)	9872 (91.2)	5735 (35.9)	5897 (29.9)	4778 (20.0)
Less than high school	2335 (3.3)	55 (0.5)	513 (3.2)	704 (3.6)	1063 (4.5)
High school (9-12) or GED	21249 (30.2)	438 (4.0)	4846 (30.3)	6835 (34.7)	9130 (38.2)
College less than graduate	17559 (25.0)	384 (3.6)	4183 (26.2)	5359 (27.2)	7633 (32.0)
Graduate	2952 (4.2)	80 (0.7)	693 (4.3)	908 (4.6)	1271 (5.3)
Causes of liver failure						< 0.001
Alcoholic cirrhosis	9857 (14.0)	2165 (20.0)	2366 (14.8)	2497 (12.7)	2829 (11.9)
Alcoholic cirrhosis with hepatitis C	4467 (6.4)	302 (2.8)	1373 (8.6)	1244 (6.3)	1548 (6.5)
Cirrhosis: Autoimmune	2486 (3.5)	568 (5.3)	696 (4.4)	629 (3.2)	593 (2.5)
Cirrhosis: Cryptogenic (Idiopathic)	5918 (8.4)	1397 (12.9)	1565 (9.8)	1515 (7.7)	1441 (6.0)
Cirrhosis: Fatty liver (NASH)	1442 (2.1)		9 (0.1)	173 (0.9)	1260 (5.3)
Cirrhosis: Hepatitis type B (HBSAG+)	2367 (3.4)	509 (4.7)	675 (4.2)	694 (3.5)	489 (2.1)
Cirrhosis: Hepatitis type C	17611 (25.0)	1849 (17.1)	4024 (25.2)	6058 (30.8)	5680 (23.8)
Other	13851 (19.7)	2344 (21.7)	3195 (20.0)	4196 (21.3)	4116 (17.2)
PLM: Hepatoma (HCC) and cirrhosis	4960 (7.1)	143 (1.3)	272 (1.7)	984 (5.0)	3561 (14.9)
PLM: Hepatoma - HCC	1954 (2.8)	173 (1.6)	141 (0.9)	423 (2.2)	1217 (5.1)
Primary biliary cirrhosis (PBC)	3762 (5.4)	1122 (10.4)	1105 (6.9)	814 (4.1)	721 (3.0)
PSC: Ulcerative colitis	1702 (2.4)	257 (2.4)	549 (3.4)	476 (2.4)	420 (1.8)

¹Contrast between period 1 and 4. GED: General education development; NASH: Non-alcoholic steatohepatitis; HCC: Hepatocellular carcinoma; PBC: Primary biliary cholangitis; PLM: Primary liver malignancy; PSC: Primary sclerosing cholangitis; (HBSAG+): Hepatitis B surface antigen-positive; SD: Standard deviation.

Table 3 Recipient perioperative data n (%)

Recipient characteristics	Total	5 yr periods				P-value¹
		Period 1	Period 2	Period 3	Period 4
		1990-1994	1995-1999	2000-2004	2005-2009
MELD (median) (Q1-Q3)
Listing	16 (12-23)	NA	NA	16 (12-23)	16 (12-23)
Transplant	18 (13-26)	NA	NA	18 (13-25)	19 (14-27)
CIT (median hours) (Q1-Q3)	8 (6.0-10.0)	10.3 (8.0-13.2)	8.5 (6.5-10.9)	7.3 (5.7-9.5)	7 (5.1-8.7)	< 0.001
WIT(median Minutes) (Q1-Q3)	45 (35.0-59.0)	58 (45.0-75.0)	48 (38.0-60.0)	40 (31.0-50.0)	40 (31.0-49.0)	< 0.001
Waiting list/inactive (median days) (Q1-Q3)	93 (21-278)	53 (14-31)	151 (45-332)	124 (27-386)	68 (15-235)	< 0.001
Hospital stay (median days) (Q1-Q3)	12 (08-20)	20 (14-31)	13 (09-21)	10 (07-17)	10 (07-16)	< 0.001

¹Contrast between period 1 and 4. CIT: Cold Ischemia Time; WIT: Warm Ischemia Time; MELD: Model for End Stage Liver Disease; (Q1-Q3): 25^th Quartile - 75^th Quartile.

Table 4 Functional status and medical condition n (%)

Recipient characteristics	Total	5 yr periods				P-value¹
		Period 1	Period 2	Period 3	Period 4
		1990-1994	1995-1999	2000-2004	2005-2009
Functional status - listing						< 0.001
Unknown	16999 (24.2)	7131 (65.9)	3916 (24.5)	4279 (21.7)	1673 (7.0)
ADL with no assistance	30882 (43.9)	1527 (14.1)	8019 (50.2)	11006 (55.9)	10330 (43.3)
ADL with some assistance	16803 (23.9)	2096 (19.4)	3772 (23.6)	4101 (20.8)	6834 (28.6)
ADL with total assistance	5693 (8.1)	75 (0.7)	263 (1.7)	317 (1.6)	5038 (21.1)
Functional status - transplant						< 0.001
Unknown	22251 (31.6)	7686 (71)	6695 (41.9)	6722 (34.1)	1148 (4.8)
ADL with no assistance	23277 (33.1)	1338 (12.4)	5959 (37.3)	8363 (42.5)	7617 (31.9)
ADL with some assistance	15434 (21.9)	1686 (15.6)	2876 (18.0)	3986 (20.2)	6886 (28.8)
ADL with total assistance	9415 (13.4)	119 (1.1)	440 (2.8)	632 (3.2)	8224 (34.5)
Medical condition - listing						< 0.001
Unknown	14394 (20.5)	83 (0.8)	76 (0.5)	5 (0.0)	14230 (59.6)
ICU	4549 (6.5)	1354 (12.5)	1208 (7.6)	1339 (6.8)	648 (2.7)
Hospitalized not in ICU	5949 (8.5)	1447 (13.4)	1615 (10.1)	1819 (9.2)	1068 (4.5)
Not Hospitalized	45485 (64.6)	7945 (73.4)	13071 (81.9)	16540 (84.0)	7929 (33.2)
Medical condition - transplant						< 0.001
Unknown	28 (0.0)	2 (0.0)	26 (0.2)
ICU	10220 (14.5)	1883 (17.4)	2824 (17.7)	2946 (15.0)	2567 (10.8)
Hospitalized not in ICU	12076 (17.2)	2219 (20.5)	3467 (21.7)	2613 (13.3)	3777 (15.8)
Not Hospitalized	48053 (68.3)	6725 (62.1)	9653 (60.4)	14144 (71.8)	17531 (73.4)

¹Contrast between period 1 and 4. ICU: Intensive care unit; ADL: Adult daily living; Unknown: Data not available.

Table 5 Medical comorbidities n (%)

Recipient characteristics	Total	5 yr periods				P-value¹
		Period 1	Period 2	Period 3	Period 4	P-value¹
		1990-1994	1995-1999	2000-2004	2005-2009
Diabetes						< 0.001
Unknown	11392 (16.2)	9331 (86.2)	848 (5.3)	714 (3.6)	499 (2.1)
No DM	47401 (67.4)	1310 (12.1)	12792 (80.1)	15326 (77.8)	17973 (75.3)
Type 1 DM	702 (1.0)			63 (0.3)	639 (2.7)
Type 2 DM	10882 (15.5)	188 (1.7)	2330 (14.6)	3600 (18.3)	4764 (20.0)
COPD						0.4
Unknown	26589 (37.8)	9359 (86.4)	1387 (8.7)	1159 (5.9)	14684 (61.5)
No	43172 (61.3)	1449 (13.4)	14412 (90.2)	18280 (92.8)	9031 (37.8)
Yes	616 (0.9)	21 (0.2)	171 (1.1)	264 (1.3)	160 (0.7)
Hypertension						< 0.001
Unknown	26387 (37.5)	9412 (86.9)	1115 (7.0)	1159 (5.9)	14701 (61.6)
No	37629 (53.5)	1288 (11.9)	13356 (83.6)	15664 (79.5)	7321 (30.7)
Yes	6361 (9.0)	129 (1.2)	1499 (9.4)	2880 (14.6)	1853 (7.8)
Angina						0.5
Unknown	28259 (40.2)	9365 (86.5)	1019 (6.4)	2103 (10.7)	15772 (66.1)
No angina	40926 (58.2)	1416 (13.1)	14567 (91.2)	17081 (86.7)	7862 (32.9)
Angina	1192 (1.7)	48 (0.4)	384 (2.4)	519 (2.6)	241 (1.0)
Dialysis						< 0.001
Unknown	9682 (13.8)	8532 (78.8)	629 (3.9)	471 (2.4)	50 (0.2)
No	57690 (82.0)	2234 (20.6)	14789 (92.6)	18282 (92.8)	22385 (93.8)
Yes	3005 (4.3)	63 (0.6)	552 (3.5)	950 (4.8)	1440 (6.0)

¹Contrast between period 1 and 4. DM: Diabetes mellitus; COPD: Chronic obstructive pulmonary disease; Unknown: Data not available.

Table 6 Graft status n (%)

Recipient characteristics	Total	5 yr periods				P-value¹
		Period 1	Period 2	Period 3	Period 4
		1990-1994	1995-1999	2000-2004	2005-2009
Graft status						< 0.0001
Not Failed	35460 (50.4)	2879 (26.6)	6221 (39)	10361 (52.6)	15999 (67)
Failed	34917 (49.6)	7950 (73.4)	9749 (61.1)	9342 (47.4)	7876 (33)
Treated for rejection ≤ 12 mo						< 0.0001
Unknown	37869 (53.8)	10081 (93.1)	12610 (79)	8066 (40.9)	7112 (29.8)
No	25835 (36.7)	145 (1.3)	2000 (12.5)	9392 (47.7)	14298 (59.9)
Yes	6673 (9.5)	603 (5.6)	1360 (8.5)	2245 (11.4)	2465 (10.3)
Causes of graft failure
Biliary						< 0.001
Unknown	23875 (68.4)	6299 (79.2)	6558 (62.3)	5989 (64.1)	5029 (63.9)
No	10098 (28.9)	1514 (19)	2981 (30.6)	3112 (33.3)	2491 (31.6)
Yes	944 (2.7)	137 (1.7)	210 (2.1)	241 (2.6)	356 (4.5)
Hep de novo						0.0006
Unknown	23854 (68.32)	6329 (79.61)	6551 (67.2)	5971 (63.92)	5003 (63.52)
No	10968 (31.41)	1591 (20.01)	3168 (32.5)	3356 (35.92)	2853 (36.22)
Yes	95 (0.27)	30 (0.38)	30 (0.31)	15 (0.16)	20 (0.25)
Hep recurrence						0.9
Unknown	23670 (67.79)	6230 (78.36)	6523 (66.91)	5929 (63.47)	4988 (63.33)
No	8086 (23.16)	1232 (15.5)	2387 (24.48)	2403 (25.72)	2064 (26.21)
Yes	3161 (9.05)	488 (6.14)	839 (8.61)	1010 (10.81)	824 (10.46)
Infection						<0.001
Unknown	23794 (68.14)	6213 (78.15)	6564 (67.33)	5986 (64.08)	5031 (63.88)
No	9429 (27)	1333 (16.77)	2690 (27.59)	2897 (31.01)	2509 (31.86)
Yes	1694 (4.85)	404 (5.08)	495 (5.08)	459 (4.91)	336 (4.27)
Primary graft failure						0.0013
Unknown	23289 (66.7)	5921 (74.48)	6475 (66.42)	5901 (63.17)	4992 (63.38)
No	8392 (24.03)	1369 (17.22)	2432 (24.95)	2521 (26.99)	2070 (26.28)
Yes	3236 (9.27)	660 (8.3)	842 (8.64)	920 (9.85)	814 (10.34)
Recurrent disease						0.3
Unknown	23686 (67.84)	6177 (77.7)	6536 (67.04)	5965 (63.85)	5008 (63.59)
No	9548 (27.34)	1464 (18.42)	2862 (29.36)	2890 (30.94)	2332 (29.61)
Yes	1683 (4.82)	309 (3.89)	351 (3.6)	487 (5.21)	536 (6.81)
Acute rejection						0.6
Unknown	23854 (68.32)	6318 (79.47)	6546 (67.15)	5969 (63.89)	5021 (63.75)
No	10374 (29.71)	1530 (19.25)	2999 (30.76)	3180 (34.04)	2665 (33.84)
Yes	689 (1.97)	102 (1.28)	204 (2.09)	193 (2.07)	190 (2.41)
Chronic rejection						<0.001
Unknown	26635 (76.28)	6507 (81.85)	7441 (76.33)	6927 (74.15)	5760 (73.13)
No	7018 (20.1)	1124 (14.14)	1949 (19.99)	2128 (22.78)	1817 (23.07)
Yes	1264 (3.62)	319 (4.01)	359 (3.68)	287 (3.07)	299 (3.8)
Vascular thrombosis						0.3
Unknown	23750 (68.02)	6231 (78.38)	6535 (67.03)	5970 (63.9)	5014 (63.66)
No	9635 (27.59)	1473 (18.53)	2780 (28.52)	2964 (31.73)	2418 (30.7)
Yes	1532 (4.39)	246 (3.09)	434 (4.45)	408 (4.37)	444 (5.64)

¹Contrast between period 1 and 4. Unknown: Data not available; Hep: Hepatitis.

Table 7 Recipient status n (%)

Recipient characteristics	Total	5 yr periods				P-value¹
		Period 1	Period 2	Period 3	Period 4
		1990-1994	1995-1999	2000-2004	2005-2009
Re-transplantation						< 0.001
No	64588 (91.8)	9586 (88.5)	14350 (89.9)	18180 (92.3)	22472 (94.1)
Yes	5789 (8.2)	1243 (11.5)	1620 (10.1)	1523 (7.7)	1403 (5.9)
Causes of death						< 0.001
Cardiovascular/cardio	2893 (9.9)	718 (10.7)	783 (9.6)	735 (9.4)	657 (10.2)
Cerebrovascular	647 (2.2)	177 (2.6)	191 (2.4)	146 (1.9)	133 (2.1)
Graft Failure	3363 (11.6)	677 (10.1)	895 (11)	948 (12.1)	843 (13)
Hemorrhage	825 (2.8)	237 (3.5)	213 (2.6)	222 (2.8)	153 (2.4)
Infection	3794 (13)	1032 (15.4)	1011 (12.4)	893 (11.4)	858 (13.3)
Malignancy	3477 (12)	704 (10.5)	847 (10.4)	931 (11.9)	995 (15.4)
Multiorgan failure	2192 (7.5)	349 (5.2)	536 (6.6)	669 (8.6)	638 (9.9)
Other	3378 (11.6)	629 (9.4)	919 (11.3)	1004 (12.9)	826 (12.8)
Pulmonary	965 (3.3)	187 (2.8)	260 (3.2)	269 (3.4)	249 (3.9)
Renal failure	708 (2.4)	208 (3.1)	237 (2.9)	167 (2.1)	96 (1.5)
Unknown	6861 (23.6)	1788 (26.7)	2232 (27.5)	1825 (23.4)	1016 (15.7)

¹Contrast between period 1 and 4. Unknown: Data not available.

Table 8 Cox proportional hazards regression of survival after liver transplantation

	Unadjusted HR (95%CI)	Adjusted HR (95%CI)¹
Over all patient survival
Period 2 (1995-1999 vs 1990-1994)	0.90 (0.87-0.93)	0.90 (0.84-0.94)
Period 3 (2000-2004 vs 1990-1994)	0.87 (0.84-0.90)	0.76 (0.72-0.81)
Period 4 (2005-2009 vs 1990-1994)	0.83 (0.80-0.86)	0.67 (0.62-0.72)
5 yr patient survival
Period 2 (1995-1999 vs 1990-1994)	0.90 (0.86-0.95)	0.90 (0.82-0.98)
Period 3 (2000-2004 vs 1990-1994)	0.90 (0.86-0.95)	0.80 (0.73-0.88)
Period 4 (2005-2009 vs 1990-1994)	0.86 (0.82-0.90)	0.73 (0.66-0.80)
Over all graft survival
Period 2 (1995-1999 vs 1990-1994)	0.90 (0.87-0.93)	0.88 (0.83-0.93)
Period 3 (2000-2004 vs 1990-1994)	0.84 (0.82-0.87)	0.74 (0.70-0.79)
Period 4 (2005-2009 vs 1990-1994)	0.80 (0.76-0.81)	0.66 (0.62-0.71)
5 yr graft survival
Period 2 (1995-1999 vs 1990-1994)	0.91 (0.87-0.95)	0.89 (0.82-0.96)
Period 3 (2000-2004 vs 1990-1994)	0.87 (0.84-0.91)	0.77 (0.71-0.84)
Period 4 (2005-2009 vs 1990-1994)	0.81 (0.76-0.84)	0.71 (0.65-0.77)

¹Adjusted for donor age, gender, BMI, ethnicity, cause of death and recipient’s age, gender, BMI, ethnicity, CIT, cause of liver failure, waitlist time, diabetes, COPD, HTN, dialysis, angina, functional status, medical condition. HR: Hazard ratio; CI: Confidence interval; CIT: Cold ischemia time; BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; HTN: Hypertension.

Citation: Ayloo S, Pentakota SR, Molinari M. Trends of characteristics and outcomes of donors and recipients of deceased donor liver transplantation in the United States: 1990 to 2013. World J Transplantation 2018; 8(5): 167-177
URL: https://www.wjgnet.com/2220-3230/full/v8/i5/167.htm
DOI: https://dx.doi.org/10.5500/wjt.v8.i5.167