ELTR 12/2008 The Present Evolution of Liver Transplantation 1. General evolution of LT in Europe 2. Donor data 3. Recipient data 4. Indications and results

ELTR12/2008 The Present Evolution of Liver

Transplantation

1. General evolution of LT in Europe

2. Donor data

3. Recipient data

4. Indications and results

5. Evolution of techniques

6. Mortality and retransplantation


Transplantation


2. Donor data

3. Recipient data




ELTR12/2008

EUROPEAN LIVER TRANSPLANT REGISTRY25 countries - 143 institutions

85,446 transplantations - 76,818 patients05/1968 - 12/2008

693

2149

4076

921

752

13701

12864

12785

371

583

10831

11

1866

653

1346

1500

174111

14992

1996

1372

1370

1625

8

ELTR12/2008 Evolution of 85,446 Liver

Transplantations in Europe

7 10 7 5 3 6 4 10 2222 15 25 2549 8284166

295

544

834

1280

1720

2111

2508

2762

3000

3330

36293757

4038

4266

4587

48214945

51425095

54215475

54875624

4196

68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 2000 2002 2004 2006 2008

ELTR12/2008 Evolution of the number of Liver

Transplantations reported to the ELTR

200

300

400

500

600

700

800

900

1000

1100

1200

FRANCE : 12493 GERMANY : 12022

GREAT BRITAIN : 11659 SPAIN : 14629

ITALY : 10554

(No LT)

ELTR12/2008 Evolution of the number of Liver

Transplantations by Center

0

20

40

60

80

100

FRANCE : 12493 GERMANY : 12022

GREAT BRITAIN : 11659 SPAIN : 14629

(No LT / Center)


Transplantation


2. Donor data

3. Recipient data




ELTR12/2008

Graft Survival according to Donor Age in Europe

01/1988 - 12/2008

76

7065

595660

52

47

74

64

57

48

43

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

<55 years : 56827

55-65 years : 10297

≥ 65 years : 7336

(%)

Yrs

Total Log Rank test p = 0.0001

ELTR12/2008 Graft Survival according to Donor Age

in Elective Liver Transplantation01/1988 – 12/2008

79

7268

6258

69

62

5247

77

66

59

50

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

<55 years : 46021

55-65 years : 8629

≥65 years : 6463

(%)

Yrs


ELTR12/2008 Graft Survival according to Donor Age

in Urgent Liver Transplantation01/1988 - 12/2008

6156

5349 46

6054

5147 44

54

4741 40

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

<55 years : 9436

55-65 years : 1469

≥65 years : 745

(%)

Yrs



Transplantation


2. Donor data

3. Recipient data




ELTR12/2008 Evolution of Recipient Age

05/1968 – 12/2008

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

68-80 82 84 86 88 90 92 94 96 98 2000 2002 2004 2006 2008

≥60 : 12952 45 to 60 : 34974 15 to 45 : 21310 2 to 15 : 3112 0 to 2 : 3112

ELTR12/2008

Patient Survival according to Recipient Age01/1988 - 12/2008

8380 79

77 7582

7570

6459

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Children : 6956

Adults : 67338

Yrs

p Log Rank = 0.0001

ELTR12/2008 Patient Survival according to

Adult Recipient Age01/1988 - 12/2008

83

7774

69 65

7570

63 59

79

70

64

55

49

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

15-45 yrs : 20295

45-60 yrs : 34173

≥ 60 yrs : 12870

(%)

Yrs

p Log Rank< 60 vs ≥ 60 yrs : 0.0001< 45 vs ≥ 45 yrs : 0.0001

ELTR12/2008

Proportion of Pediatric Transplantation by Country 01/1988 - 12/2008

6%

22%

65%

3%

13%

0%

14%

8%

10%

13%

6%

0%

7%

0%

17%

19%

11%

18%

1%

5%

9%

7%

13%

15%

7%

0% 20% 40% 60% 80% 100%

AUSTRIA

BELGIUM

BULGARIA

CZECH REPUBLIC

DENMARK

ESTONIA

FINLAND

FRANCE

GERMANY

GREAT BRITAIN

HUNGARY

IRELAND

ITALY

MONACO

NORWAY

POLAND

PORTUGAL

ROMANIA

SLOVENIA

SPAIN

SWEDEN

SWISS

NETHERLANDS

TURKEY

YUGOSLAVIA

Children Adults

10%

ELTR12/2008 Primary Indication of Liver

Transplantation in Pediatric Patients05/1968 - 12/2008

Cirrhosis : 1375%

Cholestatic diseases :

215874%

Cancers : 893%

Metabolic diseases :

2679%

Acute hepatic

failure : 2579%

0 to 2 Years(2985 children)

Cirrhosis : 37810%

Cholestatic diseases :

156643%

Cancers : 2005%

Metabolic diseases

:96926%

Acute hepatic

failure : 57416%

2 to 15 Years(3852 children)

ELTR12/2008 Graft Survival according to

Children Recipient Age01/1988 - 12/2008

7268

62

7369

6663

61

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

< 2 years : 3409

2 - 15 years : 4765

(%)

Yrs

p Log Rank = NS

ELTR12/2008

Survival of Children >= 2 yrsaccording to the Main Indication in Europe

01/1988 - 12/2008

7470 69 67 66

87 8482

81 80

90 88 8682 80

82 7976

73 68

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Acute hepatic failure : 573 Cholestatic disease : 1564Metabolic disease : 966 Cirrhosis : 356

(%)

Yrs

p Log Rank :

Cholestatic vs Metabolic : NS ACHF vs Cholestatic : 0.0001Cholestatic vs Cirrhosis : 0.003 ACHF vs Metabolic : 0.0001Metabolic vs Cirrhosis : 0.0001 ACHF vs Cirrhosis : 0.03

ELTR12/2008 Graft Survival according to Adult

Recipient Age01/1988 - 12/2008

76

6964

5854

75

66

60

52

46

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

< 60 yrs : 60679

≥ 60 yrs : 13845

Yrs

p Log Rank = 0.001

ELTR12/2008

Acute hepatic failure : 442

4%Cancers : 3075

24%

Cirrhosis : 810264%

Others : 9758%

Primary Indications of Liver Transplantion in Elderly Patients (>= 60 Years)

01/1988 - 12/2008

ELTR12/2008

Survival of Elderly Recipients (>= 60 Years) according to the Main Indication in Europe

01/1988 - 12/2008

6157

53 4841

79

66

57

4640

80

73

67

5953

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Acute hepatic failure : 442 Cancers : 3070 Cirrhosis : 8088

Yrs

AHF vs Cancers : 0.0001 (Wilcoxon test)AHF vs Cirrhosis : 0.0001Cancers vs Cirrhosis : 0.0001

(%)


Transplantation


2. Donor data

3. Recipient data




ELTR12/2008

* Others : Budd Chiari : 675 Benign liver tumors or Polycystic diseases : 934Parasitic diseases : 67 Other liver diseases : 533

Primary Diseases leading to Liver Transplantion in Europe

01/1988 - 12/2008Acute hepatic failure : 6155

9%

*Others : 22093%

Cancers : 1019914%

Cholestatic diseases : 7552

10%

Cirrhosis : 4169658%

Metabolic diseases : 4542

6%

ELTR12/2008

Acute liver diseases : 6205

9%

Chronic liver diseases :

5030469%

Metabolic diseases : 4549

6%

Other liver diseases : 624

1%

Benign tumors : 9341%

Malignant tumors : 10199

14%

Primary Indications of Liver Transplantion in Europe

01/1988 - 12/2008

ELTR12/2008

Evolution of Primary Diseases leading to Liver Transplantation in Europe

05/1968 - 12/2008

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

68-80 82 84 86 88 90 92 94 96 98 2000 2002 2004 2006 2008

Others : 14762 Acute hepatic failure : 6321 Cancers : 10707 Cirrhosis : 42514

ELTR12/2008

Primary Diseases leading to Liver Transplantion by Country

01/1988 - 12/2008

0% 20% 40% 60% 80% 100%

AUSTRIA

BELGIUM

BULGARIA

CZECH …

DENMARK

ESTONIA

FINLAND

FRANCE

GERMANY

GREAT BRITAIN

HUNGARY

IRELAND

ITALY

MONACO

NORWAY

POLAND

PORTUGAL

ROMANIA

SLOVENIA

SPAIN

SWEDEN

SWISS

THE …

TURKEY

YUGOSLAVIA

Acute hepatic failure : 6155 Cancers : 10199

Cirrhosis : 41696 Others : 14303

ELTR12/2008

Primary Diseases leading to Liver Transplantation in Adult Recipients

01/1988 - 12/2008

0% 20% 40% 60% 80% 100%

15 to 45 yrs

45 to 60 yrs

≥60 yrs

Cirrhosis : 41108 Cancers : 9894

Acute hepatic failure : 5315 Others : 9072

ELTR12/2008 Patient and Graft Survival

following Liver Transplantation05/1968 – 12/2008

53

4541 39 36

82

7571

6561

48

4036

34 31

75

6863

5753

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Patients : 2014 Patients : 74534

Grafts : 2214 Grafts : 82961

(%)

Yrs

1968 - 1988 Since 1988

ELTR12/2008 Patient Survival according to the

Year of Liver Transplantation

34

2218

64

5246

6561

56

81

66

85

79

86

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

<85 : 519 85-89 : 4129 90-94 : 12007

95-99 : 18162 2000-2004 : 22945 >2004 : 18786

Yrs

(%)

ELTR12/2008 Patient Survival according to the

Indication01/1988 - 12/2008

83

7772

6662

80

66

58

4945

6965 63

60 58

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Cirrhosis : 41576Cancers : 10172Acute hepatic failure : 6144

(%)

Yrs

Total Log Rank test p > 0.0001

Acute Hepatic Failure vs Cirrhosis : 0.0001Cancers vs Cirrhosis : 0.0001Acute Hepatic Failure vs Cancers : 0.0001 (Wilcoxon test)

p Log Rank :

ELTR12/2008

Patient Survival according to the 1st Indication01/1988 – 12/2008

84

7873

6763

787580

66

58

4945

6965

6360 58

8682

78

73 70

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Chronic Liver Diseases (CLD) : 50169

Benign Tumors : 933

Malignant Tumors : 10172

Acute Liver Diseases (ALD) : 6194

Metabolic Diseases : 4532

(%)

Yrs


ELTR12/2008

Graft Survival according to the Urgency of Liver Transplantation in Europe

01/1988 - 12/2008

79

7166

595560

5451

4745

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Non Urgency : 67267

Urgency : 13126

(%)

Yrs

p Log Rank = 0.0001

ELTR12/2008

Graft Survival according to ABO Compatibility In Elective Liver Transplantation

01/1988 - 12/2008

7971

66

6055

72

6560

5652

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Isogroup : 60990

Compatible : 3465

(%)

Yrs

p Log Rank = 0.0001

ELTR12/2008

Graft Survival according to ABO Compatibility In Urgent Liver Transplantation

01/1988 - 12/2008

6256

5349

46

5954 46

3731 29 26

24

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Isogroup : 9370Compatible : 2571Incompatible : 456

(%)

Yrs

isogr vs comp : NSisogr vs Incomp : 0.0001 comp vs Incomp : 0.0001

p Log Rank :

p Log Rank = 0.0001

ELTR12/2008

Virus related : 1593638%

Alcoholic : 1363833%

Viral + Alcoholic : 1759

4%

Autoimmune : 17865%

Secondary Biliary : 495

1%

Unknown causes : 3274

8%

Primary Biliary : 427710%

Others : 5311%

Liver Transplantation in EuropeIndications in 41696 Cirrhosis

01/1988 - 12/2008

ELTR12/2008

Evolution of Indications for Cirrhosisin Europe

05/1968 - 12/2008

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

68-80 82 84 86 88 90 92 94 96 98 2000 2002 2004 2006 2008

Alcoholic cirrhosis : 13731 Primary biliary cirrhosis : 4595Virus related cirrhosis : 16069

ELTR12/2008

Survival of Patients with Cirrhosisas the First Indication

01/1988 - 12/2008

82

7470 60

79 74

6560

8682

7974

71

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Virus Related Cirrhosis : 15865Alcoholic Cirrhosis : 13616Primary Biliary Cirrhosis : 4273

(%)

Yrs

Virus vs Alcoholic : 0.01Virus vs PBC : 0.0001Alcoholic vs PBC : 0.0001

p Log Rank :

ELTR12/2008

Virus B : 389324%

Virus C : 985962%

Virus BD : 11988%

Virus BC : 4%

Virus BCD : 1451%

Other virus : 1511%

Primary Indications of Liver Transplantationin 15936 Virus related Cirrhosis in Europe

01/1988 - 12/2008

ELTR12/2008

Survival of Patients with Virus related Cirrhosis as the First Indication

01/1988 - 12/2008

8377

74

7068

9390

88 85 848175

6965

60

94 90

83 82

67

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Virus B : 3865 Virus BD : 1191

Virus BC : 688 Virus BCD : 144

(%)

Yrs

(%)

ELTR12/2008


01/1988 - 12/2008

81

7166

5854

8175

6965

60

9490

83 82

67

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Virus C : 9826 Virus BC : 688 Virus BCD : 144

(%)

Yrs

(%)

ELTR12/2008


01/1988 - 12/2008

81

7368

6258

8985

8178

76

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Single viral infection * : 13847

Viral coinfection ** : 2018

(%)

Yrs

p Log Rank = 0.0001

ELTR12/2008 Liver Transplantation in Europe

Indications in 10199 Hepato-Biliary Cancers01/1988 - 12/2008

Hepatocellular carcinoma :

862885%

Others : 5565%

Cholangiocellular carcinoma :

2973%

Metastases : 4805%

Carcinoma biliary tract :

2382%

ELTR12/2008

Evolution of Indications for Hepato-BiliaryCancers in Europe

05/1968 - 12/2008

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

68-80

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008

*Others : 603 Metastases : 538

Carcinoma biliary : 284 Cholangiocellular carcinoma : 352

Hepatocellular carcinoma : 8930

ELTR12/2008

Survival of Patients with Liver Canceras the First Indication

01/1988 - 12/2008

82

68

60

5247

57

45

35

26

64

40

30

23 20

66

43

3223

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Hepatocellular carcinoma : 8612 Metastases : 477

Cholangiocellular carcinoma : 294 Carcinoma biliary tract : 237

Yrs

HCC vs cholang : 0.0001HCC vs Metas : 0.0001HCC vs biliary : 0.0001cholang vs Metas : 0.005cholang vs biliary : NSMetas vs biliary : 0.01

ELTR12/2008

Survival of Patients with HCC with and without underlying Cirrhosis

01/1988 - 12/2008

83

72

64

5550

83

70

62 54 4971

52

4335

31

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Cirrhosis and incidental HCC : 3600

HCC with cirrhosis : 7875

HCC without cirrhosis : 735

(%)

ELTR12/2008

Fulminant or Subfulminant

hepatitis : 523985%

Subacute hepatitis : 440

7%

Others : 4768%

Primary Indications of Liver Transplantationin 6155 Patients with Acute Hepatic Failure

01/1988 - 12/2008

ELTR12/2008

Survival of Patients with Acute Hepatic Failure as the First Indication

01/1988 - 12/2008

6965 63

6058

76

71 6966

626461

5957

54

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Fulminant or Subfulminant hepatitis : 5230Subacute hepatitis : 475Others : 439

(%)

Yrs

Total Log Rank test p= 0.04(%)

Subacute vs Fulm. : NSSubacute vs others : 0,001Fulm. vs others : NS

p Log Rank :

ELTR12/2008

Primary Indications of Liver Transplantationin 7552 Patients with Cholestatic Diseases

01/1988 - 12/2008

Primary sclerosing

cholangitis : 329744%

Other non congenital

biliary diseases : 4225%

Biliary atresia : 307141%

Other congenital

biliary diseases : 76210%

ELTR12/2008

Survival of Patients with Cholestatic Diseases as the First Indication

01/1988 - 12/2008

87

7873 70

8479 73

84 82 81 80

77

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Primary sclerosing cholangitis : 3293Other non congenital biliary diseases : 421Biliary atresia : 3066Other congenital biliary diseases : 758

(%)

Yrs

Total Log Rank test p = 0.01(%)

ELTR12/2008

Wilson disease : 76817%

Hemochromatosis : 430

10%

Others : 164636%

Alpha-1 Antitrypsin deficiency :

51211%

Amyloïdotic polyneurop. :

118626%

Primary Indications of Liver Transplantationin 4542 Patients with Metabolic Diseases

01/1988 - 12/2008

ELTR12/2008

Survival of Patients with Metabolic Diseases as the First Indication

01/1988 - 12/2008

87 86 85 8379

7672

67

54 51

8682

7874

70

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Wilson disease : 765 Hemochromatosis : 429Others : 3331

(%)

Yrs

Total Log Rank test p= 0.0001

ELTR12/2008 Indications of Liver Transplantation

in 2183 Other liver diseases in Europe05/1968 - 12/2008

Budd Chiari : 67532%

Benign liver tumors : 266

12%Parasitic

diseases : 673%

Other liver diseases

(unprecised): 46822%

Polycystic diseases : 668

31%

ELTR12/2008

Survival of Patients with Other Liver Diseases as the First Indication

01/1988 - 12/2008

78

6966

8077

7472

6973

7067

61 59

8988

8580

77

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Budd Chiari : 674 Benign liver tumors : 266

Parasitic diseases : 67 Other liver diseases : 494

Polycystic disease : 667Yrs

(%)


Transplantation


2. Donor data

3. Recipient data




ELTR12/2008

Graft Survival in Liver Transplantation only vs Liver Combined to other Organ Transplantation

01/1988 - 12/2008

43

32

6853

78

7469

74 74 74 74 74

73 70

54

55 55

47

53 63

0

20

40

60

80

100

0 1 2 3 4 5

Clusters : 22 Heart : 50 Kidney : 1674 Langerhans Islet : 14

Lung : 61 Pancreas : 69 Small bowel : 92 Grafts : 71151

Yrs

(%)

ELTR12/2008 Graft Survival according to the Site of

Transplantation in Elective LT 01/1988 - 12/2008

69

5449

4035

79

7166

5955

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Heterotopic : 106

Orthotopic : 66216

(%)

Yrs

p Log Rank = 0.0001

ELTR12/2008 Type of Liver Graft in Europe

according to the Date of Transplantation

60%

65%

70%

75%

80%

85%

90%

95%

100%

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Others : 10298 Cadaveric Full size : 71780

ELTR12/2008

Graft Survival according to the Type of Graft

01/1988 - 12/2008

76

69

64

5754

72

6663

5955

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Cadaveric Full size : 69786

Others : 10160

(%)

Yrs

p Log rank < 0.0001

ELTR12/2008 Graft Survival according to the Type of Graft

01/1988 - 12/2008

6964

54

80

7369

6464

60

5755

65 6257

53

78

68

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Cadaveric full size : 69786

Living donor : 3067

Reduced liver : 2385

Split liver : 4092

Domino : 616

(%)

Yrs

Total Log rank test = 0.0001

ELTR12/2008

Graft Survival according to the Type of Graft in Elective Liver Transplantation

01/1988 - 12/2008

7971

56

81

7470

6668 65 63

60 75 67

6156

70

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Cadaveric Full size : 57510Living donor : 2773Reduced liver : 1470Split liver : 1470Domino : 576


p Log rank :Cadaveric full size vs Living donor : 0.01Cadaveric full size vs Reduced liver : 0.0001 (Wilcoxon test)Cadaveric full size vs Split liver : NSLiving donor vs Reduced liver : 0.0001Living donor vs Split liver : 0.001Reduced liver vs Split liver : NS

ELTR12/2008

Graft Survival according to the Type of Graft in Urgent Liver Transplantation

01/1988 - 12/2008

61

5552

4845

6461 60 59

4644

4140

52

46 4442 40

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Cadaveric Full size : 10765

Living donor : 248

Reduced liver : 874

Split liver : 819


p Log rank :Cadaveric full size vs Living donor : NSCadaveric full size vs Reduced liver : 0.001Cadaveric full size vs Split liver : 0.0001Living donor vs Reduced liver : 0.01Living donor vs Split liver : 0.001Reduced liver vs Split liver : NS

ELTR12/2008 Graft Survival according to the Cold Ischemic

Time in UW Elective Liver Transplantation 01/1988 - 12/2008

82

7469

57

76

6964

54

69

6258

49

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

0-6 heures : 10016

6-12 heures : 29702

12-15 heures : 7088

≥15 heures : 2336

(%Total Log Rank test p = 0.0001

< 6 vs ≥ 6 hrs : 0.0002< 12 vs ≥ 12 hrs : 0.0001< 15 vs ≥ 15 hrs : 0.0001

p Log Rank :

ELTR12/2008

Graft Survival according to the Cold Ischemic Time in UW Urgent Liver Transplantation

01/1988 - 12/2008

6357

5350 4656

50 4843

41

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

0-6 heures : 1715

6-12 heures : 6223

12-15 heures : 1208

≥15 heuress : 384

(%)

Yrs

Total Log Rank test p = NS

< 6 vs ≥ 6 hrs : NS< 12 vs ≥ 12 hrs :NS< 15 vs ≥ 15 hrs : NS

p Log Rank :

ELTR12/2008 Auxiliary vs Non Auxiliary Graft Survival

in Elective Liver Transplantation 01/1988 - 12/2008

78 7166

5955

82

7165

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Non Auxiliary : 59765

Auxiliary : 289

(%)

Yrs

p Log Rank = NS

ELTR12/2008 Auxiliary vs Non Auxiliary Graft Survival

in Urgent Liver Transplantation 01/1988 - 12/2008

5954

5147

445449

45

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Non Auxiliary : 11625

Auxiliary : 184

(%)

Yrs

p Log Rank = NS


Transplantation


2. Donor data

3. Recipient data




ELTR12/2008 Liver Transplantation in Europe

Mortality and Retransplantation01/1988 - 12/2008

5 6

1521

917

9

174

23

20

17

9

13

6

10

0

5

10

15

20

25

30

35

40

45

1 day 1 week 1 month 6 months

1 year 3 years 5 years > 5 years

Retransplantation

Death

Cumulative proportions

Percentage per period

RetxDeath

3%5%

26%11%

45%26%

62%47%

100%100%

89%82%

84%73%

71%56%

ELTR12/2008

Graft Survival according to the Number of Liver Transplantations in Europe

01/1988 - 12/2008

7870

6559

555750

4641

37

49

4339

3330

49

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

1st LT : 74574 2nd LT : 74373rd LT : 858 4th LT : 90

(%)

1st LT vs 2nd LT : 0.0001 2nd LT vs 3rd LT : 0.00051st LT vs 3rd LT : 0.0001 2nd LT vs 4th LT : NS1st LT vs4th LT : 0.0001 3rd LT vs 4th LT : NS

p Log Rank :

ELTR12/2008 Graft Survival according to the number of the

Liver Transplantation in Elective Cases 01/1988 - 12/2008

79

7267

6056

6556

51 4541

63

5447

39 36

55

46

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

1st liver transplantations : 63777

2nd liver transplantations : 3103

3rd liver transplantations : 351

4th liver transplantations : 35

(%)

1st LT vs 2nd LT : 0.0001 2nd LT vs 3rd LT : NS1st LT vs 3rd LT : 0.0001 2nd LT vs 4th LT : NS1st LT vs4th LT : 0.03 3rd LT vs 4th LT : NS

p Log Rank :

ELTR12/2008

Graft Survival according to the number of the Liver Transplantation in Urgent Cases

01/1988 - 12/2008

6459

5653

505145 42

3734

36

34 31 27

4136

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

1st liver transplantations : 8693

2nd liver transplantations : 3943

3rd liver transplantations : 441

4th liver transplantations : 48

(%)

Yrs

1st LT vs 2nd LT : 0.0001 2nd LT vs 3rd LT : 0.00011st LT vs 3rd LT : 0.0001 2nd LT vs 4th LT : NS1st LT vs4th LT : 0.04 3rd LT vs 4th LT : NS

ELTR12/2008

Patient Survival according to the number of Liver Transplantations

01/1988 - 12/2008

83 7772

676370

6157

5047

74

60

5347

44

86

70

60

51

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Patients with 1 LT : 67270




(%)

Yrs

p Log Rank :1st LT vs 2nd LT : 0.0001 2nd LT vs 3rd LT : NS1st LT vs 3rd LT : 0.0001 2nd LT vs 4th LT : NS1st LT vs4th LT : 0.01 3rd LT vs 4th LT : NS

ELTR12/2008 Patient Survival according to the number

of LTs in Elective cases for the 1st LT 01/1988 - 12/2008

85 7873

676371 62

5750

46

76

6255

4945

85

71

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10


Patients with 2 LTs : 5322



(%)

Yrs

p Log Rank :1st LT vs 2nd LT : 0.0001 2nd LT vs 3rd LT : NS1st LT vs 3rd LT : 0.0001 2nd LT vs 4th LT : NS1st LT vs4th LT : 0.01 3rd LT vs 4th LT : NS

ELTR12/2008

Patient Survival according to the number of LTs in Urgent cases for the 1st LT

01/1988 – 12/2008

7067 64

61 5964 55

51 4954

41 39

82

59

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Patients with 1 LT : 7580 Patients with 2 LTs : 921

Patients with 3 LTs : 167 Patients with 4 LTs : 17

(%)

Yrs

1st LT vs 2nd LT : 0.0001 2nd LT vs 3rd LT : NS1st LT vs 3rd LT : 0.0008 2nd LT vs 4th LT : NS1st LT vs4th LT : NS 3rd LT vs 4th LT : NS

p Log Rank :

ELTR12/2008

Mortality following the 1st LT 01/1988 - 12/2008

510

109

213

161

78

111

238

21370 95

29 50

19

80

105 116 13950 71

135

228477

232 368

208

346 776

300

22777

146

407

342

627118

749

1239

266

264108

221

327

4971048

1146

292 481296

856

46 45 97 157 74 143 79 179

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 day 1 week 1 month 6 months 1 year 3 years 5 years > 5 years

Others : 820 General causes : 4943

Infections : 2984 Tumor de Novo : 1604

Tumoral recurrence : 1858 Non tumoral recurrence : 1450

Rejection : 585 Technical complications : 884

Primary non function or dysfunction : 483 Peroperative : 510

ELTR12/2008

Causes of Retransplant following the 1st LT01/1988 - 12/2008

149919

302

39

372

556

457

153 232 8795

4 40

135

208

194233

87

111

8

57

76177

88

160

2 17 2518 7 13 2 14

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 day 1 week 1 month 6 months 1 year 3 years 5 years > 5 years

Others : 98 Infections : 117

Tumor de Novo : 26 Tumoral recurrence : 19

Non tumoral recurrence : 576 Rejection : 1003

Technical complications : 1991 Primary non function or dysfunction : 1370

Documents

ELTR 12/2008 The Present Evolution of Liver Transplantation 1. General evolution of LT in Europe 2. Donor data 3. Recipient data 4. Indications and results