the present evolution of liver transplantation
DESCRIPTION
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. The Present Evolution of Liver Transplantation. - PowerPoint PPT PresentationTRANSCRIPT
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
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
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)
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
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
Total Log Rank test p = 0.0001
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
Total Log Rank test p = 0.001
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
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
(%)
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
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
Total Log Rank test p = 0.0001
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
Survival of Patients with Virus related Cirrhosis as the First Indication
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
Survival of Patients with Virus related Cirrhosis as the First Indication
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
(%)
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
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
Total Log rank test = 0.0001
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
Total Log rank test = 0.0001
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
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
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
Patients with 2 LT : 6445
Patients with 3 LT : 733
Patients with 4 LT : 84
(%)
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 1 LT : 57831
Patients with 2 LTs : 5322
Patients with 3 LTs : 537
Patients with 4 LTs : 62
(%)
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