Liver transplantations in Finland over 40 years: evolution and recent trends

Liver transplantation (LT) is a life-saving treatment for patients with end-stage liver disease, with significant improvements in short-term survival over the decades. However, long-term survival and trends in LT indications and outcomes remain areas of active research. This registry-based study evaluates 40 years of LT in Finland, assessing patient and graft survival, retransplantation rates, changing recipient and donor demographics, indications and benchmarking outcomes against international standards.

Data were extracted from the nationwide Finnish LT registry, covering all LTs performed in Finland between 1982 and 2024. Survival analyses were estimated using the Kaplan-Meier methodology and retransplantation rates were assessed using the cumulative incidence function. Benchmark cases were defined by international criteria.

A total of 1763 LTs were performed, with a mean recipient age of 46 years. The most common aetiologies were alcohol-related liver disease (19%) and primary sclerosing cholangitis (PSC; 16%). Over time, recipient and donor age, body mass index and prevalence of diabetes increased. One-year patient survival improved from 83% in the 1980s to 96% in 2020-2024, with the overall 5-year, 10-year, 20-year and 30-year patient survival being 83%, 73%, 53% and 28%, respectively. The retransplantation rate was 13% at 30 years overall and 28% in PSC. Benchmark cases had one-year patient and graft survival rates of 97% and 96%, respectively. Acute rejection rates declined from 62% during 1980-1989 to 19% during 2022-2023. Post-transplant kidney-replacement therapy peaked at 26% in 2010-2021, thereafter decreasing to 8% after the year 2022.

The Finnish LT programme demonstrates sustained improvements in short- and mid-term survival, with evolving indications and recipient and donor demographics. Benchmark analyses confirm high-quality outcomes. Continued efforts are needed to optimise long-term survival and reduce the need for retransplantation, especially in PSC.