1 Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.
2 Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA.
3 Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN.
4 Department of Pediatrics, University of Washington, Seattle, WA.
5 Organ Procurement and Transplantation Network, Richmond, VA.
6 United Network for Organ Sharing, Richmond, VA.
7 Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
8 Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN.
Data on adult liver transplants performed in the US in 2017 are notable for (1) continued growth in numbers of new waitlist registrants (11,514) and of transplants performed (8,082); (2) continued increase in the transplant rate (51.5 per 100 waitlist-years); (3) a precipitous decrease in waitlist registrations and transplants for hepatitis C-related indications; (4) reciprocal increases in waitlist registrants and recipients with alcoholic liver disease and with clinical profiles consistent with non-alcoholic fatty liver disease; and (5) continued improvement in graft survival despite changing recipient characteristics such as older age and higher rates of obesity. Variability in transplant rates remained by candidate race, presence of hepatocellular carcinoma, urgency status (status 1A versus model for end-stage liver disease (MELD) score >35), and geography. More than half of all children listed for liver transplant in 2017 were aged younger than 5 years in 2017, and the highest rate of pretransplant mortality persisted for children aged younger than 1 year. Children underwent transplant at higher acuity than the past, as evidenced by higher MELD/pediatric end-stage liver disease scores and listings at status 1A and 1B. Higher acuity at transplant is likely due to lack of access to suitable donor organs, which has been compensated for by persistent trends toward use of partial or split liver grafts and ABO-incompatible grafts. Despite higher illness severity scores at transplant, pediatric graft and patient survival posttransplant have improved over time.