Increasing rate of liver transplantation in Iceland over the last decade: a nationwide study

Liver transplantation in Iceland has historically been infrequent, with primary biliary cholangitis the leading indication during 1984-2012. We analyzed trends in the incidence, indications, etiology, and outcomes of liver transplantation in Iceland from 2013 to 2024 and compared transplant rates with other Nordic countries.

This nationwide retrospective cohort study included all Icelandic residents transplanted between January 2013 and December 2024, with adults and children analyzed separately. Indications, aetiology, and clinical outcomes were obtained from electronic medical records at Landspítali University Hospital. Crude rates were compared with Nordic countries in the Scandiatransplant registry and age- and sex-standardized rates were calculated for the adult Icelandic cohort.

Sixty transplantations, including four re-transplantations, were performed in 56 adult patients (61% male; median age 56 years), and seven in children. The mean annual crude rate was 16.0 per million per year, higher than Denmark (9.2), Finland (12.1), and Estonia (7.7), but lower than Norway (17.9) and Sweden (17.5). Leading aetiologies were metabolic dysfunction-associated steatotic liver disease (23.2%) and alcohol-related liver disease (19.6%). Overall survival was 96%, 94%, and 87% at 1, 3, and 5 years, although mortality was 4.6-fold higher than in the matched general population.

Liver transplantation increased over the study period, driven mainly by metabolic dysfunction-associated steatotic liver disease and alcohol-related liver disease, a shift from the earlier dominance of autoimmune liver disease. Post-transplant survival was comparable to that reported by other Nordic and European registries, yet mortality remained above that in the matched general population.