OPTN/SRTR 2019 Annual Data Report: Liver
Summary
In 2019, liver transplant policies changed, increasing transplants and improving survival. Wait times decreased for many, and alcohol-related liver disease became a more common transplant reason.
Area of Science:
- Hepatology and Transplant Surgery
- Public Health Policy
- Organ Allocation Systems
Background:
- Significant policy changes impacted liver transplant allocation in 2019, including the Model for End-Stage Liver Disease (MELD) exception points and the National Liver Review Board.
- The national acuity circle liver distribution policy was briefly implemented before reverting to traditional boundaries.
Purpose of the Study:
- To analyze the impact of 2019 policy changes on liver transplant waiting lists, registrations, and outcomes.
- To evaluate trends in liver transplant indications and recipient demographics.
Main Methods:
- Analysis of national liver transplant data from 2019, focusing on waiting list changes, transplant numbers, and policy implementation.
- Comparison of transplant rates, waiting times, and patient survival before and after policy modifications.
Main Results:
- Liver transplant waiting list registrations and performed transplants increased in 2019, with a notable 31% rise in living-donor liver transplants.
- Median waiting time decreased for candidates with MELD scores of 15-34, potentially linked to policy changes prioritizing non-exception candidates.
- Hepatitis C as an indication declined, while alcohol-related liver disease and non-alcoholic steatohepatitis increased; graft and patient survival improved despite sicker recipients.
Conclusions:
- 2019 policy changes appear to have positively influenced liver transplant volume and reduced waiting times for certain patient groups.
- Shifting indications towards alcohol-related and non-alcoholic steatohepatitis, alongside improved survival in older, sicker patients, highlight evolving transplant landscape.
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