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Liver transplantation in the Nordic countries - An intention to treat and post-transplant analysis from The Nordic Liver Transplant Registry 1982-2013.

Fosby B, Melum E, Bjøro K, Bennet W, Rasmussen A, Andersen IM, Castedal M, Olausson M, Wibeck C, Gotlieb M, Gjertsen H, Toivonen L, Foss S, Makisalo H, Nordin A, Sanengen T, Bergquist A, Larsson ME, Soderdahl G, Nowak G, Boberg KM, Isoniemi H, Keiding S, Foss A, Line PD, Friman S, Schrumpf E, Ericzon BG, Höckerstedt K, Karlsen TH - Scand. J. Gastroenterol. (2015)

Bottom Line: We aimed to summarize key outcome measures and developments for the activity up to December 2013.Outcome has improved over time, and for patients transplanted during 2004-2013, overall one-, five- and 10-year survival rates were 91%, 80% and 71%, respectively.In an intention-to-treat analysis, corresponding numbers during the same time period were 87%, 75% and 66%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Section for Transplantation Surgery, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital , Oslo , Norway.

ABSTRACT

Aim and background: The Nordic Liver Transplant Registry (NLTR) accounts for all liver transplants performed in the Nordic countries since the start of the transplant program in 1982. Due to short waiting times, donor liver allocation has been made without considerations of the model of end-stage liver disease (MELD) score. We aimed to summarize key outcome measures and developments for the activity up to December 2013.

Materials and methods: The registry is integrated with the operational waiting-list and liver allocation system of Scandiatransplant (www.scandiatransplant.org) and accounted at the end of 2013 for 6019 patients out of whom 5198 were transplanted. Data for recipient and donor characteristics and relevant end-points retransplantation and death are manually curated on an annual basis to allow for statistical analysis and the annual report.

Results: Primary sclerosing cholangitis, acute hepatic failure, alcoholic liver disease, primary biliary cirrhosis and hepatocellular carcinoma are the five most frequent diagnoses (accounting for 15.3%, 10.8%, 10.6%, 9.3% and 9.0% of all transplants, respectively). Median waiting time for non-urgent liver transplantation during the last 10-year period was 39 days. Outcome has improved over time, and for patients transplanted during 2004-2013, overall one-, five- and 10-year survival rates were 91%, 80% and 71%, respectively. In an intention-to-treat analysis, corresponding numbers during the same time period were 87%, 75% and 66%, respectively.

Conclusion: The liver transplant program in the Nordic countries provides comparable outcomes to programs with a MELD-based donor liver allocation system. Unique features comprise the diagnostic spectrum, waiting times and the availability of an integrated waiting list and transplant registry (NLTR).

No MeSH data available.


Related in: MedlinePlus

(A) Patient Kaplan–Meier survival after first liver transplantation (LTX) between 2001 and 2013, subdivided according to model of end-stage liver disease (MELD) score. (B) Patient Kaplan–Meier survival curves per disease category for first LTX during the period of 1982 and 2013. (C) Patient Kaplan–Meier survival curves stratified by retransplantation status for LTX performed between 1982 and 2013. (D) Patient Kaplan–Meier survival curves according to different time periods between 1982 and 2013.
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Figure 0002: (A) Patient Kaplan–Meier survival after first liver transplantation (LTX) between 2001 and 2013, subdivided according to model of end-stage liver disease (MELD) score. (B) Patient Kaplan–Meier survival curves per disease category for first LTX during the period of 1982 and 2013. (C) Patient Kaplan–Meier survival curves stratified by retransplantation status for LTX performed between 1982 and 2013. (D) Patient Kaplan–Meier survival curves according to different time periods between 1982 and 2013.

Mentions: When all indications were included for the entire study period, the overall survival rates after first LTX in the Nordic countries were 85 % at 1 year, 75% at 5 years and 64% at 10 years. When analyzing patients transplanted within the 10 last years (2004–2013) the corresponding figures were 91%, 80% and 71%, respectively. Patient survival rates for the four major patient groups are shown in Figure 2B. The patient survival has improved significantly over the years as is displayed in Figure 2D, which shows the survival rates during five different time periods. Of note, survival curves for patients undergoing LTX during the two latest five-year time periods are practically identical. There are distinct differences in patient survival rates according to diagnosis (Table II). Inferior long time survival is notable for patients receiving a liver allograft on the basis of HCV with a 5-year survival of 73% and malignant disease; HCC and cholangiocarcinoma (CCA), with 5-year survival rates of 66% and 42%, respectively (Table II). Recipients above the age of 60 years operated within the last 10 years have on average 1-, 3- and 5-year survival probabilities of 88%, 78% and 73%, respectively. During this period, 32 patients above the age of 70 years have received a first liver graft with 1- and 3-year patient survival rates of 97% and 81%, respectively.


Liver transplantation in the Nordic countries - An intention to treat and post-transplant analysis from The Nordic Liver Transplant Registry 1982-2013.

Fosby B, Melum E, Bjøro K, Bennet W, Rasmussen A, Andersen IM, Castedal M, Olausson M, Wibeck C, Gotlieb M, Gjertsen H, Toivonen L, Foss S, Makisalo H, Nordin A, Sanengen T, Bergquist A, Larsson ME, Soderdahl G, Nowak G, Boberg KM, Isoniemi H, Keiding S, Foss A, Line PD, Friman S, Schrumpf E, Ericzon BG, Höckerstedt K, Karlsen TH - Scand. J. Gastroenterol. (2015)

(A) Patient Kaplan–Meier survival after first liver transplantation (LTX) between 2001 and 2013, subdivided according to model of end-stage liver disease (MELD) score. (B) Patient Kaplan–Meier survival curves per disease category for first LTX during the period of 1982 and 2013. (C) Patient Kaplan–Meier survival curves stratified by retransplantation status for LTX performed between 1982 and 2013. (D) Patient Kaplan–Meier survival curves according to different time periods between 1982 and 2013.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4487534&req=5

Figure 0002: (A) Patient Kaplan–Meier survival after first liver transplantation (LTX) between 2001 and 2013, subdivided according to model of end-stage liver disease (MELD) score. (B) Patient Kaplan–Meier survival curves per disease category for first LTX during the period of 1982 and 2013. (C) Patient Kaplan–Meier survival curves stratified by retransplantation status for LTX performed between 1982 and 2013. (D) Patient Kaplan–Meier survival curves according to different time periods between 1982 and 2013.
Mentions: When all indications were included for the entire study period, the overall survival rates after first LTX in the Nordic countries were 85 % at 1 year, 75% at 5 years and 64% at 10 years. When analyzing patients transplanted within the 10 last years (2004–2013) the corresponding figures were 91%, 80% and 71%, respectively. Patient survival rates for the four major patient groups are shown in Figure 2B. The patient survival has improved significantly over the years as is displayed in Figure 2D, which shows the survival rates during five different time periods. Of note, survival curves for patients undergoing LTX during the two latest five-year time periods are practically identical. There are distinct differences in patient survival rates according to diagnosis (Table II). Inferior long time survival is notable for patients receiving a liver allograft on the basis of HCV with a 5-year survival of 73% and malignant disease; HCC and cholangiocarcinoma (CCA), with 5-year survival rates of 66% and 42%, respectively (Table II). Recipients above the age of 60 years operated within the last 10 years have on average 1-, 3- and 5-year survival probabilities of 88%, 78% and 73%, respectively. During this period, 32 patients above the age of 70 years have received a first liver graft with 1- and 3-year patient survival rates of 97% and 81%, respectively.

Bottom Line: We aimed to summarize key outcome measures and developments for the activity up to December 2013.Outcome has improved over time, and for patients transplanted during 2004-2013, overall one-, five- and 10-year survival rates were 91%, 80% and 71%, respectively.In an intention-to-treat analysis, corresponding numbers during the same time period were 87%, 75% and 66%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Section for Transplantation Surgery, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital , Oslo , Norway.

ABSTRACT

Aim and background: The Nordic Liver Transplant Registry (NLTR) accounts for all liver transplants performed in the Nordic countries since the start of the transplant program in 1982. Due to short waiting times, donor liver allocation has been made without considerations of the model of end-stage liver disease (MELD) score. We aimed to summarize key outcome measures and developments for the activity up to December 2013.

Materials and methods: The registry is integrated with the operational waiting-list and liver allocation system of Scandiatransplant (www.scandiatransplant.org) and accounted at the end of 2013 for 6019 patients out of whom 5198 were transplanted. Data for recipient and donor characteristics and relevant end-points retransplantation and death are manually curated on an annual basis to allow for statistical analysis and the annual report.

Results: Primary sclerosing cholangitis, acute hepatic failure, alcoholic liver disease, primary biliary cirrhosis and hepatocellular carcinoma are the five most frequent diagnoses (accounting for 15.3%, 10.8%, 10.6%, 9.3% and 9.0% of all transplants, respectively). Median waiting time for non-urgent liver transplantation during the last 10-year period was 39 days. Outcome has improved over time, and for patients transplanted during 2004-2013, overall one-, five- and 10-year survival rates were 91%, 80% and 71%, respectively. In an intention-to-treat analysis, corresponding numbers during the same time period were 87%, 75% and 66%, respectively.

Conclusion: The liver transplant program in the Nordic countries provides comparable outcomes to programs with a MELD-based donor liver allocation system. Unique features comprise the diagnostic spectrum, waiting times and the availability of an integrated waiting list and transplant registry (NLTR).

No MeSH data available.


Related in: MedlinePlus