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Trends in liver transplantation for autoimmune liver diseases: a Canadian study
Carla F Murillo Perez1, Tommy Ivanics1, Marco P A W Claasen1
1From the Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Ont. (Murillo Perez, Hirschfield, Hansen); the Multi-Organ Transplant Program, University Health Network, Toronto, Ont. (Ivanics, Claasen, Yoon, Wallace, Selzner, Sapisochin); the Department of Surgery, Henry Ford Hospital, Detroit, Mich. (Ivanics); the Department of Surgical Sciences, Akademiska sjukhuset, Uppsala University, Uppsala, Sweden (Ivanics); the Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands (Claasen); the Department of Surgery, Westmead Hospital, Sydney, Australia (Yoon); the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK (Wallace); the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK (Wallace); and the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Hansen).
Background:
To our knowledge, no analysis of data from liver transplantation registries exists in Canada. We aimed to describe temporal trends in the number of liver transplantation procedures, patient characteristics and posttransplantation outcomes for autoimmune liver diseases (AILDs) in Canada.
Methods:
We used administrative data from the Canadian Organ Replacement Register, which contains liver transplantation information from 6 centres in Canada. This study included transplantation information from 5 of the centres, as liver transplantation procedures in children were not included. We included adult (age ≥ 18 yr) patients with a diagnosis of primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH) or overlap syndrome (PBC-AIH or PSC-AIH) who received a liver transplant from 2000 to 2018.
Results:
Of 5722 primary liver transplantation procedures performed over the study period, 1070 (18.7%) were for an AILD: 489 (45.7%) for PSC, 341 (31.9%) for PBC, 220 (20.6%) for AIH and 20 (1.9%) for overlap syndrome. There was a significant increase in the absolute number of procedures for PSC, with a yearly increase of 0.6 (95% confidence interval 0.1 to 1.2), whereas the absolute number of procedures for PBC and AIH remained stable. The proportion of transplantation procedures decreased for PBC and AIH but remained stable for PSC. Recipient age at transplantation increased over time for males with PBC (median 53 yr in 2000-2005 to 57 yr in 2012-2018, p = 0.03); whereas the median age among patients with AIH decreased, from 53 years in 2000-2005 to 44 years in 2006-2011 (p = 0.03). The Model for Endstage Liver Disease score at the time of transplantation increased over time for all AILDs, particularly AIH (median 16 in 2000-2005 v. 24 in 2012-2018, p < 0.001). There was a trend toward improved survival in the PBC group, with a 5-year survival rate of 81% in 2000-2005 and 90% in 2012-2018 (p = 0.06).
Conclusion:
Between 2000 and 2018, the absolute number of liver transplantation procedures in Canada increased for PSC but remained stable for PBC and AIH; proportionally, PBC and AIH decreased as indications for transplantation. Posttransplantation survival improved only for the PBC group. An improved understanding of trends and outcomes on a national scale among patients with AILD undergoing liver transplantation can identify disparities and areas for potential health care improvement.
