ELTR
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
12/2008
ELTR
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
12/2008
EUROPEAN LIVER TRANSPLANT REGISTRY
25 countries - 143 institutions
85,446 transplantations - 76,818 patients
05/1968 - 12/2008
752
1996
653
8
693
583
1866
12785
1346
12864
4076
921
13701
1372
10831
14992
1500
11
2149
111
371
174
16
25
1370
ELTR
12/2008
ELTR
12/2008
Evolution of 85,446 Liver
Transplantations in Europe
5475 5624
5421 5487
5142
5095
4945
4821
4587
4266
4038
4196
3757
3629
3330
3000
2762
2508
2111
1720
1280
834
544
7 10 7 5
68
70
3
72
82 84
6 4 10 22 22 15 25 25 49
74
76
78
80
82
295
166
84
86
88
90
92
94
96
98
2000 2002 2004 2006 2008
Evolution of the number of Liver
Transplantations reported to the ELTR
(No LT)
1200
1100
1000
900
800
700
600
500
400
300
200
FRANCE : 12493
GERMANY : 12022
GREAT BRITAIN : 11659
SPAIN : 14629
ITALY : 10554
ELTR
12/2008
Evolution of the number of Liver
Transplantations by Center
(No LT / Center)
100
80
60
40
20
0
FRANCE : 12493
GERMANY : 12022
GREAT BRITAIN : 11659
SPAIN : 14629
ELTR
12/2008
ELTR
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
12/2008
ELTR
Graft Survival according to Donor
Age in Europe
12/2008
01/1988 - 12/2008
(%)
100
<55 years : 56827
Total Log Rank test p = 0.0001
55-65 years : 10297
76
80
≥ 65 years : 7336
70
74
60
65
64
60
59
57
52
56
47
48
40
43
20
0
0
1
2
3
4
5
6
7
8
9
10
Yrs
ELTR
Graft Survival according to Donor Age 12/2008
in Elective Liver Transplantation
01/1988 – 12/2008
(%)
100
Total Log Rank test p = 0.0001
<55 years : 46021
55-65 years : 8629
79
80
72
69
77
60
≥65 years : 6463
68
62
62
66
58
52
59
40
47
50
20
0
0
1
2
3
4
5
6
7
8
9
10Yrs
ELTR
Graft Survival according to Donor Age12/2008
in Urgent Liver Transplantation
01/1988 - 12/2008
(%)
100
Total Log Rank test p = 0.001
<55 years : 9436
55-65 years : 1469
80
≥65 years : 745
61
60
56
60
53
54
54
40
49
46
47
44
51
47
41
40
5
6
20
0
0
1
2
3
4
7
8
9
Yrs
10
ELTR
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
12/2008
ELTR
Evolution of Recipient Age
12/2008
05/1968 – 12/2008
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
68-80
82
84
≥60 : 12952
86
88
90
45 to 60 : 34974
92
94
96
15 to 45 : 21310
98
2000
2002
2 to 15 : 3112
2004
2006
0 to 2 : 3112
2008
ELTR
Patient Survival according to Recipient Age 12/2008
01/1988 - 12/2008
100
p Log Rank = 0.0001
83
80
80
79
77
75
82
75
70
60
64
59
40
Children : 6956
Adults : 67338
20
0
0
1
2
3
4
5
6
7
8
9
10
Yrs
Patient Survival according to
Adult Recipient Age
01/1988 - 12/2008
(%)
100
83
77
75
80
79
74
70
70
60
69
65
63
59
64
55
49
40
15-45 yrs : 20295
45-60 yrs : 34173
20
p Log Rank
< 60 vs ≥ 60 yrs : 0.0001
< 45 vs ≥ 45 yrs : 0.0001
≥ 60 yrs : 12870
0
0
1
2
3
4
5
6
7
8
9
10 Yrs
ELTR
12/2008
Proportion of Pediatric Transplantation by Country ELTR
12/2008
01/1988 - 12/2008
YUGOSLAVIA
7%
TURKEY
15%
NETHERLANDS
13%
SWISS
7%
SWEDEN
9%
SPAIN
5%
SLOVENIA
1%
ROMANIA
18%
PORTUGAL
11%
POLAND
19%
NORWAY
17%
MONACO
0%
ITALY
7%
IRELAND
0%
HUNGARY
6%
GREAT BRITAIN
13%
GERMANY
10%
8%
FRANCE
FINLAND
14%
ESTONIA
0%
DENMARK
13%
CZECH REPUBLIC
3%
BULGARIA
65%
BELGIUM
22%
AUSTRIA
6%
0%
20%
40%
Children
60%
80%
Adults
100%
10%
Primary Indication of Liver
Transplantation in Pediatric Patients
ELTR
12/2008
05/1968 - 12/2008
Metabolic
diseases :
Cancers : 89 267
9%
3%
Acute
hepatic
failure : 257
9%
Cirrhosis :
137
5%
0 to 2 Years
(2985 children)
Cholestatic
diseases :
2158
74%
Acute
hepatic
failure : 574
16%
Metabolic
diseases
:969
26%
Cirrhosis :
378
10%
Cancers :
200
5%
2 to 15 Years
(3852 children)
Cholestatic
diseases :
1566
43%
ELTR
Graft Survival according to
Children Recipient Age
12/2008
01/1988 - 12/2008
(%)
100
80
73
69
72
66
63
62
68
60
61
40
< 2 years : 3409
2 - 15 years : 4765
20
p Log Rank = NS
0
0
1
2
3
4
5
6
7
8
9
10
Yrs
ELTR
Survival of Children >= 2 yrs
12/2008
according to the Main Indication in Europe
01/1988 - 12/2008
100
(%)
80
90
87
88
84
82
74
79
86
82
82
81
76
70
80
80
68
66
73
67
69
60
40
p Log Rank :
20
Cholestatic vs Metabolic : NS
Cholestatic vs Cirrhosis : 0.003
Metabolic vs Cirrhosis : 0.0001
ACHF vs Cholestatic : 0.0001
ACHF vs Metabolic : 0.0001
ACHF vs Cirrhosis : 0.03
0
0
1
2
3
4
Acute hepatic failure : 573
Metabolic disease : 966
5
6
7
8
9
Cholestatic disease : 1564
Cirrhosis : 356
Yrs
10
Graft Survival according to Adult
Recipient Age
01/1988 - 12/2008
100
76
80
69
75
64
58
66
60
54
60
52
46
40
< 60 yrs : 60679
20
p Log Rank = 0.001
≥ 60 yrs : 13845
0
0
1
2
3
4
5
6
7
8
9
10Yrs
ELTR
12/2008
Primary Indications of Liver Transplantion
in Elderly Patients (>= 60 Years)
01/1988 - 12/2008
Others : 975
8%
Cirrhosis :
8102
64%
Acute hepatic
failure : 442
4%
Cancers : 3075
24%
ELTR
12/2008
Survival of Elderly Recipients (>= 60 Years) ELTR
12/2008
according to the Main Indication in Europe
01/1988 - 12/2008
(%)
100
80
80
79
73
67
66
60
59
57
61
57
53
48
53
41
46
40
40
AHF vs Cancers : 0.0001 (Wilcoxon test)
AHF vs Cirrhosis : 0.0001
Cancers vs Cirrhosis : 0.0001
20
Yrs
0
0
1
2
3
Acute hepatic failure : 442
4
5
6
Cancers : 3070
7
8
9
10
Cirrhosis : 8088
ELTR
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
12/2008
ELTR
Primary Diseases leading to Liver 12/2008
Transplantion in Europe
01/1988 - 12/2008
Metabolic
diseases : 4542
6%
Cirrhosis : 41696
58%
* Others :
Budd Chiari : 675
Parasitic diseases : 67
Acute hepatic
failure : 6155
9%
*Others : 2209
3%
Cancers : 10199
14%
Cholestatic
diseases : 7552
10%
Benign liver tumors or Polycystic diseases : 934
Other liver diseases : 533
Primary Indications of Liver
Transplantion in Europe
01/1988 - 12/2008
Benign tumors Malignant
tumors : 10199
: 934
14%
1%
Other liver
diseases : 624
1%
Acute liver
diseases : 6205
9%
Metabolic
diseases : 4549
6%
Chronic liver
diseases :
50304
69%
ELTR
12/2008
Evolution of Primary Diseases leadingELTR
12/2008
to Liver Transplantation in Europe
05/1968 - 12/2008
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
68-80
82
84
Others : 14762
86
88
90
92
94
Acute hepatic failure : 6321
96
98
2000
Cancers : 10707
2002
2004
2006
2008
Cirrhosis : 42514
Primary Diseases leading to Liver Transplantion by Country ELTR
12/2008
01/1988 - 12/2008
YUGOSLAVIA
TURKEY
THE …
SWISS
SWEDEN
SPAIN
SLOVENIA
ROMANIA
PORTUGAL
POLAND
NORWAY
MONACO
ITALY
IRELAND
HUNGARY
GREAT BRITAIN
GERMANY
FRANCE
FINLAND
ESTONIA
DENMARK
CZECH …
BULGARIA
BELGIUM
AUSTRIA
0%
20%
40%
60%
80%
Acute hepatic failure : 6155
Cancers : 10199
Cirrhosis : 41696
Others : 14303
100%
Primary Diseases leading to Liver
Transplantation in Adult Recipients
01/1988 - 12/2008
≥60 yrs
45 to 60 yrs
15 to 45 yrs
0%
20%
40%
60%
80%
Cirrhosis : 41108
Cancers : 9894
Acute hepatic failure : 5315
Others : 9072
100%
ELTR
12/2008
Patient and Graft Survival
following Liver Transplantation
05/1968 – 12/2008
(%)
1968 - 1988
100
82
80
75
75
Patients : 2014
Patients : 74534
Grafts : 2214
Grafts : 82961
71
68
60
Since 1988
65
63
57
53
45
41
48
40
61
40
36
53
39
36
34
31
20
0
0
1
2
3
4
5
6
7
8
9
10 Yrs
ELTR
12/2008
Patient Survival according to the
Year of Liver Transplantation
100
(%)
86
85
80
79
81
66
65
64
61
60
56
52
46
40
34
20
22
18
0
0
1
2
3
4
5
6
7
8
9
10Yrs
<85 : 519
85-89 : 4129
90-94 : 12007
95-99 : 18162
2000-2004 : 22945
>2004 : 18786
ELTR
12/2008
Patient Survival according to the
Indication
01/1988 - 12/2008
(%)
Cirrhosis : 41576
Cancers : 10172
Acute hepatic failure : 6144
Total Log Rank test p > 0.0001
100
83
77
80
72
80
66
65
69
63
62
66
60
60
58
58
49
45
40
p Log Rank :
20
Acute Hepatic Failure vs Cirrhosis : 0.0001
Cancers vs Cirrhosis : 0.0001
Acute Hepatic Failure vs Cancers : 0.0001 (Wilcoxon test)
0
0
1
2
3
4
5
6
7
8
9
10 Yrs
ELTR
12/2008
ELTR
Patient Survival according to the 1st Indication12/2008
01/1988 – 12/2008
Chronic Liver Diseases (CLD) : 50169
Benign Tumors : 933
(%)
Total Log Rank test p = 0.0001
100
Malignant Tumors : 10172
Acute Liver Diseases (ALD) : 6194
86
84
80
80
Metabolic Diseases : 4532
82
78
78
73
73
78
65
69
66
60
75
70
67
63
58
63
58
60
49
45
40
20
0
0
1
2
3
4
5
6
7
8
9
10
Yrs
ELTR
Graft Survival according to the Urgency12/2008
of Liver Transplantation in Europe
01/1988 - 12/2008
100(%)
Non Urgency : 67267
p Log Rank = 0.0001
Urgency : 13126
79
80
71
66
59
60
55
60
54
51
47
40
45
20
0
0
1
2
3
4
5
6
7
8
9
10Yrs
ELTR
Graft Survival according to ABO Compatibility 12/2008
In Elective Liver Transplantation
01/1988 - 12/2008
100
(%)
Isogroup : 60990
p Log Rank = 0.0001
Compatible : 3465
79
80
71
66
72
60
65
60
60
55
56
52
40
20
0
0
1
2
3
4
5
6
7
8
9
Yrs
10
ELTR
Graft Survival according to ABO Compatibility 12/2008
In Urgent Liver Transplantation
01/1988 - 12/2008
100
(%)
Isogroup : 9370
Compatible : 2571
Incompatible : 456
p Log Rank = 0.0001
80
62
60
56
59
53
49
54
46
37
40
31
20
p Log Rank :
46
29
26
24
isogr vs comp : NS
isogr vs Incomp : 0.0001
comp vs Incomp : 0.0001
0
0
1
2
3
4
5
6
7
8
9
10Yrs
Liver Transplantation in Europe
Indications in 41696 Cirrhosis
01/1988 - 12/2008
Primary Biliary : Others : 531
Unknown
4277
1%
causes : 3274
10%
8%
Secondary
Biliary : 495
1%
Autoimmune :
1786
5%
Viral + Alcoholic
: 1759
4%
Alcoholic :
13638
33%
Virus related :
15936
38%
ELTR
12/2008
Evolution of Indications for Cirrhosis
in Europe
ELTR
12/2008
05/1968 - 12/2008
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
68-80
82
84
86
88
90
Alcoholic cirrhosis : 13731
Virus related cirrhosis : 16069
92
94
96
98
2000
2002
2004
2006
Primary biliary cirrhosis : 4595
2008
Survival of Patients with Cirrhosis
as the First Indication
01/1988 - 12/2008
100(%)
86
80
82
82
79
79
74
74
74
71
70
60
60
65
60
p Log Rank : Virus vs Alcoholic : 0.01
Virus vs PBC : 0.0001
Alcoholic vs PBC : 0.0001
40
Virus Related Cirrhosis : 15865
Alcoholic Cirrhosis : 13616
Primary Biliary Cirrhosis : 4273
20
0
0
1
2
3
4
5
6
7
8
9
Yrs
10
ELTR
12/2008
ELTR
Primary Indications of Liver Transplantation12/2008
in 15936 Virus related Cirrhosis in Europe
01/1988 - 12/2008
Virus BC :
4%
Virus BCD : Other virus :
151
145
1%
1%
Virus BD :
1198
8%
Virus C : 9859
62%
Virus B : 3893
24%
Survival of Patients with Virus related
Cirrhosis as the First Indication
01/1988 - 12/2008
(%)
(%)
100
94
93
81
83
80
90
90
75
77
60
88
83
74
85
82
84
69
65
70
68
67
60
40
20
0
0
1
2
3
4
5
6
7
8
9
Virus B : 3865
Virus BD : 1191
Virus BC : 688
Virus BCD : 144
Yrs
10
ELTR
12/2008
Survival of Patients with Virus related
Cirrhosis as the First Indication
01/1988 - 12/2008
(%)
(%)
100
94
90
81
81
80
83
75
82
69
71
67
65
66
60
60
58
54
40
20
0
0
1
2
3
Virus C : 9826
4
5
6
Virus BC : 688
7
8
9
Yrs
10
Virus BCD : 144
ELTR
12/2008
Survival of Patients with Virus related
Cirrhosis as the First Indication
01/1988 - 12/2008
(%)
100
p Log Rank = 0.0001
89
85
80
81
78
76
81
73
68
60
62
58
40
Single viral infection * : 13847
Viral coinfection ** : 2018
20
0
0
1
2
3
4
5
6
7
8
9
10 Yrs
ELTR
12/2008
ELTR
12/2008
Liver Transplantation in Europe
Indications in 10199 Hepato-Biliary Cancers
01/1988 - 12/2008
Cholangiocellul
ar carcinoma :
297
3%
Others : 556
5%
Metastases :
480
5%
Carcinoma
biliary tract :
238
2%
Hepatocellular
carcinoma :
8628
85%
Evolution of Indications for Hepato-Biliary ELTR
12/2008
Cancers in Europe
05/1968 - 12/2008
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
6880
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
Survival of Patients with Liver Cancer
as the First Indication
01/1988 - 12/2008
100
HCC vs cholang : 0.0001
HCC vs Metas : 0.0001
HCC vs biliary : 0.0001
cholang vs Metas : 0.005
cholang vs biliary : NS
Metas vs biliary : 0.01
82
80
68
66
64
60
60
57
52
43
40
47
45
40
35
32
23
26
30
20
23
20
0
0
1
2
3
4
5
6
7
8
9
Hepatocellular carcinoma : 8612
Metastases : 477
Cholangiocellular carcinoma : 294
Carcinoma biliary tract : 237
Yrs
10
ELTR
12/2008
Survival of Patients with HCC with and
without underlying Cirrhosis
01/1988 - 12/2008
100
(%)
Cirrhosis and incidental HCC : 3600
83
80
60
HCC with cirrhosis : 7875
83
72
71
70
HCC without cirrhosis : 735
64
54
62
49
55
52
40
50
43
35
31
20
0
0
1
2
3
4
5
6
7
8
9
10
ELTR
12/2008
Primary Indications of Liver TransplantationELTR
12/2008
in 6155 Patients with Acute Hepatic Failure
01/1988 - 12/2008
Subacute
hepatitis : 440
7%
Others : 476
8%
Fulminant or
Subfulminant
hepatitis :
5239
85%
Survival of Patients with Acute Hepatic
Failure as the First Indication
01/1988 - 12/2008
(%)
Fulminant
or Subfulminant hepatitis : 5230
Total Log Rank test p= 0.04
Subacute hepatitis : 475
Others : 439
(%)
100
76
80
71
65
69
64
60
69
63
61
66
60
59
62
58
57
54
40
p Log Rank :
20
Subacute vs Fulm. : NS
Subacute vs others : 0,001
Fulm. vs others : NS
0
0
1
2
3
4
5
6
7
8
9
10 Yrs
ELTR
12/2008
ELTR
Primary Indications of Liver Transplantation 12/2008
in 7552 Patients with Cholestatic Diseases
01/1988 - 12/2008
Other
congenital
biliary diseases
: 762
10%
Biliary atresia :
3071
41%
Primary
sclerosing
cholangitis :
3297
44%
Other non
congenital
biliary diseases
: 422
5%
Survival of Patients with Cholestatic
Diseases as the First Indication
01/1988 - 12/2008
(%)
Total Log Rank test p = 0.01
100(%)
87
80
84
84
82
79
78
81
80
73
77
73
70
60
40
Primary sclerosing cholangitis : 3293
Other non congenital biliary diseases : 421
Biliary atresia : 3066
Other congenital biliary diseases : 758
20
0
0
1
2
3
4
5
6
7
8
9
10 Yrs
ELTR
12/2008
Primary Indications of Liver Transplantation
in 4542 Patients with Metabolic Diseases
01/1988 - 12/2008
Amyloïdotic
polyneurop. :
1186
26%
Alpha-1
Antitrypsin
deficiency :
512
11%
Wilson disease
: 768
17%
Hemochromato
sis : 430
10%
Others : 1646
36%
ELTR
12/2008
Survival of Patients with Metabolic
Diseases as the First Indication
01/1988 - 12/2008
(%)
100
87
86
86
80
85
82
76
83
78
72
79
74
70
67
60
54
51
40
20
Total Log Rank test p= 0.0001
0
0
1
2
3
Wilson disease : 765
Others : 3331
4
5
6
7
8
9
Hemochromatosis : 429
10Yrs
ELTR
12/2008
ELTR
Indications of Liver Transplantation 12/2008
in 2183 Other liver diseases in Europe
05/1968 - 12/2008
Polycystic
diseases : 668
31%
Other liver
diseases
(unprecised):
468
22%
Budd Chiari :
675
32%
Parasitic
diseases : 67
3%
Benign liver
tumors : 266
12%
Survival of Patients with Other Liver
Diseases as the First Indication
01/1988 - 12/2008
(%)
100
89
88
80
80
85
77
78
73
80
74
70
72
67
60
77
69
66
69
61
59
40
20
Budd Chiari : 674
Benign liver tumors : 266
Parasitic diseases : 67
Other liver diseases : 494
Polycystic disease : 667
Yrs
0
0
1
2
3
4
5
6
7
8
9
10
ELTR
12/2008
ELTR
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
12/2008
Graft Survival in Liver Transplantation only vs Liver ELTR
12/2008
Combined to other Organ Transplantation
01/1988 - 12/2008
(%)
100
60
78
74
73
54
68
40
43
80
74
70
53
55
74
74
74
74
69
63
53
55
47
32
20
0
0
1
2
3
4
Yrs
5
Clusters : 22
Heart : 50
Kidney : 1674
Langerhans Islet : 14
Lung : 61
Pancreas : 69
Small bowel : 92
Grafts : 71151
Graft Survival according to the Site of
Transplantation in Elective LT
01/1988 - 12/2008
100
Heterotopic : 106
p Log Rank = 0.0001
(%)
Orthotopic : 66216
79
80
71
66
59
69
60
55
54
49
40
40
35
20
0
0
1
2
3
4
5
6
7
8
9
10 Yrs
ELTR
12/2008
ELTR
Type of Liver Graft in Europe according
to the Date of Transplantation
12/2008
100%
95%
90%
85%
80%
75%
70%
65%
60%
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
ELTR
Graft Survival according to the
Type of Graft
12/2008
01/1988 - 12/2008
100
Cadaveric Full size : 69786
(%)
Others : 10160
p Log rank < 0.0001
76
80
69
72
64
66
60
59
63
55
57
54
40
20
0
0
1
2
3
4
5
6
7
8
9
10
Yrs
ELTR
Graft Survival according to the Type of Graft
12/2008
01/1988 - 12/2008
(%)
100
Cadaveric full size : 69786
Living donor : 3067
Total Log rank test = 0.0001
Reduced liver : 2385
80
80
Split liver : 4092
78
68
64
60
73
69
Domino : 616
69
64
62
57
60
65
64
57
55
54
53
40
20
0
0
1
2
3
4
5
6
7
8
9
Yrs
10
ELTR
Graft Survival according to the Type of 12/2008
Graft in Elective Liver Transplantation
01/1988 - 12/2008
100
Cadaveric Full size : 57510
Living donor : 2773
Reduced liver : 1470
Split liver : 1470
Domino : 576
Total Log rank test = 0.0001
81
80
79
75
74
71
70
70
67
65
68
60
66
63
60
56
61
40
56
p Log rank :
Cadaveric full size vs Living donor : 0.01
Cadaveric full size vs Reduced liver : 0.0001 (Wilcoxon test)
Cadaveric full size vs Split liver : NS
Living donor vs Reduced liver : 0.0001
Living donor vs Split liver : 0.001
Reduced liver vs Split liver : NS
20
0
0
1
2
3
4
5
6
7
8
9
10
Graft Survival according to the Type of
Graft in Urgent Liver Transplantation
01/1988 - 12/2008
100
Cadaveric Full size : 10765
Total Log rank test = 0.0001
Living donor : 248
Reduced liver : 874
80
Split liver : 819
61
61
60
64
60
55
52
46
59
52
46
40
p Log rank :
Cadaveric full size vs Living donor : NS
Cadaveric full size vs Reduced liver : 0.001
Cadaveric full size vs Split liver : 0.0001
Living donor vs Reduced liver : 0.01
Living donor vs Split liver : 0.001
Reduced liver vs Split liver : NS
20
48
44
45
41
44
40
40
42
0
0
1
2
3
4
5
6
7
8
9
10
ELTR
12/2008
ELTR
Graft Survival according to the Cold Ischemic12/2008
Time in UW Elective Liver Transplantation
01/1988 - 12/2008
(%
100
Total Log Rank test p = 0.0001
82
80
74
69
76
69
69
60
57
64
62
58
54
49
40
0-6 heures : 10016
p Log Rank :
6-12 heures : 29702
< 6 vs ≥ 6 hrs : 0.0002
< 12 vs ≥ 12 hrs : 0.0001
< 15 vs ≥ 15 hrs : 0.0001
12-15 heures : 7088
20
≥15 heures : 2336
0
0
1
2
3
4
5
6
7
8
9
10
Graft Survival according to the Cold IschemicELTR
12/2008
Time in UW Urgent Liver Transplantation
01/1988 - 12/2008
100
(%)
Total Log Rank test p = NS
0-6 heures : 1715
6-12 heures : 6223
80
12-15 heures : 1208
≥15 heuress : 384
63
57
60
53
50
56
50
46
48
40
43
41
p Log Rank :
< 6 vs ≥ 6 hrs : NS
< 12 vs ≥ 12 hrs :NS
< 15 vs ≥ 15 hrs : NS
20
0
0
1
2
3
4
5
6
7
8
9
10 Yrs
Auxiliary vs Non Auxiliary Graft Survival
in Elective Liver Transplantation
01/1988 - 12/2008
(%)
100
p Log Rank = NS
Non Auxiliary : 59765
82
80
Auxiliary : 289
71
78
66
59
71
60
55
65
40
20
0
0
1
2
3
4
5
6
7
8
9
Yrs
10
ELTR
12/2008
Auxiliary vs Non Auxiliary Graft Survival
in Urgent Liver Transplantation
01/1988 - 12/2008
100
(%)
Non Auxiliary : 11625
p Log Rank = NS
Auxiliary : 184
80
59
60
54
54
51
49
40
47
44
45
20
0
0
1
2
3
4
5
6
7
8
9
Yrs
10
ELTR
12/2008
ELTR
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
12/2008
Liver Transplantation in Europe
Mortality and Retransplantation
01/1988 - 12/2008
Percentage per period
45
Retransplantation
40
Death
35
30
17
25
20
20
5
0
9
21
15
4
5
Cumulative proportions
3%
5%
26%
11%
45%
26%
6
17
17
9
6
1 day 1 week 1 month
Retx
Death
10
23
15
10
13
9
6
1 year 3 years 5 years
months
62%
47%
71%
56%
84%
73%
89%
82%
>5
years
100%
100%
ELTR
12/2008
ELTR
Graft Survival according to the Number of
Liver Transplantations in Europe
12/2008
01/1988 - 12/2008
100
(%)
1st LT : 74574
3rd LT : 858
2nd LT : 7437
4th LT : 90
78
80
70
65
59
57
60
55
50
49
49
46
41
43
40
37
39
33
30
p Log Rank :
20
1st LT vs 2nd LT : 0.0001
1st LT vs 3rd LT : 0.0001
1st LT vs4th LT : 0.0001
2nd LT vs 3rd LT : 0.0005
2nd LT vs 4th LT : NS
3rd LT vs 4th LT : NS
0
0
1
2
3
4
5
6
7
8
9
10
ELTR
Graft Survival according to the number of the12/2008
Liver Transplantation in Elective Cases
01/1988 - 12/2008
1st liver transplantations : 63777
100 (%)
2nd liver transplantations : 3103
3rd liver transplantations : 351
79
80
4th liver transplantations : 35
72
65
60
55
56
63
60
67
54
51
46
47
40
45
41
36
39
p Log Rank :
20
56
1st LT vs 2nd LT : 0.0001
1st LT vs 3rd LT : 0.0001
1st LT vs4th LT : 0.03
2nd LT vs 3rd LT : NS
2nd LT vs 4th LT : NS
3rd LT vs 4th LT : NS
0
0
1
2
3
4
5
6
7
8
9
10
Graft Survival according to the number of the ELTR
12/2008
Liver Transplantation in Urgent Cases
01/1988 - 12/2008
100
(%)
1st liver transplantations : 8693
2nd liver transplantations : 3943
3rd liver transplantations : 441
80
4th liver transplantations : 48
64
60
59
56
53
51
45
41
40
42
50
37
36
36
34
34
27
31
20
1st LT vs 2nd LT : 0.0001
1st LT vs 3rd LT : 0.0001
1st LT vs4th LT : 0.04
0
2nd LT vs 3rd LT : 0.0001
2nd LT vs 4th LT : NS
3rd LT vs 4th LT : NS
Yrs
0
1
2
3
4
5
6
7
8
9
10
Patient Survival according to the
number of Liver Transplantations
01/1988 - 12/2008
100
(%)
Patients with 1 LT : 67270
Patients with 2 LT : 6445
Patients with 3 LT : 733
Patients with 4 LT : 84
86
80
77
83
72
70
74
70
67
61
60
57
60
60
63
50
51
53
47
47
40
44
20
p Log Rank :
1st LT vs 2nd LT : 0.0001
1st LT vs 3rd LT : 0.0001
1st LT vs4th LT : 0.01
0
0
1
2
2nd LT vs 3rd LT : NS
2nd LT vs 4th LT : NS
3rd LT vs 4th LT : NS
3
4
5
6
7
8
9
10Yrs
ELTR
12/2008
Patient Survival according to the number
of LTs in Elective cases for the 1st LT
01/1988 - 12/2008
100
(%)
Patients with 1 LT : 57831
Patients with 2 LTs : 5322
85
Patients with 3 LTs : 537
78
85
76
80
Patients with 4 LTs : 62
73
71
62
71
60
67
63
57
62
50
55
46
49
40
45
p Log Rank :
20
1st LT vs 2nd LT : 0.0001
1st LT vs 3rd LT : 0.0001
1st LT vs4th LT : 0.01
2nd LT vs 3rd LT : NS
2nd LT vs 4th LT : NS
3rd LT vs 4th LT : NS
0
0
1
2
3
4
5
6
7
8
9
10Yrs
ELTR
12/2008
Patient Survival according to the number of ELTR
12/2008
LTs in Urgent cases for the 1st LT
01/1988 – 12/2008
(%)
p Log Rank :
100
1st LT vs 2nd LT : 0.0001
1st LT vs 3rd LT : 0.0008
1st LT vs4th LT : NS
82
80
70
67
60
64
59
64
2nd LT vs 3rd LT : NS
2nd LT vs 4th LT : NS
3rd LT vs 4th LT : NS
61
55
59
51
54
40
49
41
20
39
Patients with 1 LT : 7580
Patients with 2 LTs : 921
Patients with 3 LTs : 167
Patients with 4 LTs : 17 Yrs
0
0
1
2
3
4
5
6
7
8
9
10
ELTR
Mortality following the 1st LT
12/2008
01/1988 - 12/2008
100%
46
45
97
157
74
143
292
481
79
179
90%
80%
856
1146
497
70%
60%
296
327
1048
264
108
266
78
407
342
146
50%
221
109
1239
118
40%
19
30%
510
213
1 day
77
1 week
227
80
208
238
135
105
213
116
70
139
95
6 months
1 year
3 years
161
0%
627
776
300
111
20%
10%
749
346
1 month
228
477
232
368
50
29
71
50
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
> 5 years
Causes of Retransplant following the 1st LT
01/1988 - 12/2008
100%
2
4
17
25
8
40
90%
135
39
80%
18
7
13
12/2008
2
14
57
76
177
372
88
208
70%
ELTR
160
60%
194
556
233
50%
40%
87
149
30%
111
919
457
20%
153
302
232
87
10%
0%
1 day
1 week
1 month
6 months
1 year
3 years
5 years
95
> 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