Survival Outcomes of Liver Transplantation Amid Rising Recipient and Donor Risk Profiles.
[BACKGROUND] Advances in liver transplantation (LT) have improved recipients' short-term survival.
- p-value p < 0.001
- 95% CI 0.87-0.92
APA
Ashwat E, Spitz FJ, et al. (2025). Survival Outcomes of Liver Transplantation Amid Rising Recipient and Donor Risk Profiles.. Clinical transplantation, 39(11), e70349. https://doi.org/10.1111/ctr.70349
MLA
Ashwat E, et al.. "Survival Outcomes of Liver Transplantation Amid Rising Recipient and Donor Risk Profiles.." Clinical transplantation, vol. 39, no. 11, 2025, pp. e70349.
PMID
41137651
Abstract
[BACKGROUND] Advances in liver transplantation (LT) have improved recipients' short-term survival. Whether similar gains extend to long-term outcomes remains unclear.
[METHODS] We conducted a retrospective analysis of adult, first-time LTs performed in the United States from 2002 to 2018, with follow-up through December 31, 2023. Patients were grouped into three eras: 2002-2007, 2008-2013, and 2014-2018. Exclusions were ABO-incompatible transplants, multivisceral or split grafts, and non-hepatocellular carcinoma malignancies. Survival was estimated with Kaplan-Meier methods; Cox proportional hazards models adjusted for primary indication, sex, Liver Transplant Risk Score (LTRS), and Donor Risk Index (DRI).
[RESULTS] Among 82,696 recipients, 23,656 underwent LT in 2002-2007, 29,355 in 2008-2013, and 29,685 in 2014-2018. Despite increasing LTRS and DRI over time, mortality was significantly lower in 2014-2018 than in earlier eras at 90 days, 1 year, and 5 years (all p < 0.001). Long-term survival improved across all LTRS strata except LTRS ≥ 7. Relative to 2002-2007, adjusted hazards for death were 0.89 (95% CI, 0.87-0.92; p < 0.001) in 2008-2013 and 0.67 (95% CI, 0.64-0.69; p < 0.001) in 2014-2018.
[CONCLUSIONS] Despite rising recipient complexity and broader use of higher-risk donors, both short- and long-term LT survival improved in the United States over the past two decades.
[METHODS] We conducted a retrospective analysis of adult, first-time LTs performed in the United States from 2002 to 2018, with follow-up through December 31, 2023. Patients were grouped into three eras: 2002-2007, 2008-2013, and 2014-2018. Exclusions were ABO-incompatible transplants, multivisceral or split grafts, and non-hepatocellular carcinoma malignancies. Survival was estimated with Kaplan-Meier methods; Cox proportional hazards models adjusted for primary indication, sex, Liver Transplant Risk Score (LTRS), and Donor Risk Index (DRI).
[RESULTS] Among 82,696 recipients, 23,656 underwent LT in 2002-2007, 29,355 in 2008-2013, and 29,685 in 2014-2018. Despite increasing LTRS and DRI over time, mortality was significantly lower in 2014-2018 than in earlier eras at 90 days, 1 year, and 5 years (all p < 0.001). Long-term survival improved across all LTRS strata except LTRS ≥ 7. Relative to 2002-2007, adjusted hazards for death were 0.89 (95% CI, 0.87-0.92; p < 0.001) in 2008-2013 and 0.67 (95% CI, 0.64-0.69; p < 0.001) in 2014-2018.
[CONCLUSIONS] Despite rising recipient complexity and broader use of higher-risk donors, both short- and long-term LT survival improved in the United States over the past two decades.
MeSH Terms
Humans; Liver Transplantation; Male; Female; Retrospective Studies; Middle Aged; Follow-Up Studies; Survival Rate; Risk Factors; Prognosis; Graft Survival; Tissue Donors; Adult; Transplant Recipients; Postoperative Complications; United States; Aged; Graft Rejection