LIVER TRANSPLANT AT THE UNIVERSITY OF PENNSYLVANIA 2015

CH 8 : Kelsey Lloyd, Arwin Thomasson, Kim Olthoff, and Abraham Shaked

Abstract

In this brief report, we summarize activity and trends in liver transplantation within the Penn Liver Transplant Program, including total program activity, recipient characteristics, waitlist time to transplant, graft and patient survival, rate of retransplantation, and multi-organ transplantation activity, as well as post-transplant hospital length of stay. Results: Penn Transplant has performed 2478 total adult liver transplants to date,
consisting of 2382 deceased-donor liver transplants and 96 living-donor liver transplants. Recipient race is approximately 70% white, 20%
black, and 10% “other” races including Hispanic, Asian, and American Indian/Alaskan Native. Non-cholestatic cirrhosis is the leading indication
for liver transplantation, accounting for more than half of all cases throughout the selected time interval. Most patients are not hospitalized
at the time of transplantation, and there has been a reduction in the number of patients hospitalized in the intensive care unit at the time
of transplant in the past five years. The median time to transplant is 13.2 months. Hazard ratios (HRs) for graft failure after one month, one year, and three years post-transplant were reported as: 0.54, 1.05, 1.01 (adult deceased donor) and 0.58, 0.57, 1.16 (adult living donor); HRs for patient survival were reported as: 0.44, 1.03, 1.04 (adult deceased donor) and 0.73, 0.74, 0.69 (adult living donor) for the same time increments. Penn averaged a 2.3% retransplantation rate and a total multi-organ transplant volume of 13. The mean length of hospital stay following transplantation was 8.83 days. Conclusion: Our program activity data mirrors trends that are seen in many of the established busy liver transplant centers in the United States. There is greater recognition that liver transplantation can be offered to a larger number of candidates who are diagnosed with progressive liver failure of primary cancer in the setting of liver cirrhosis, and there is an increase in donor organs from either extended criteria cadaveric donors or living donors. Despite more complex candidate populations and increased utilization of extended criteria donors, Penn’s outcomes continue to be excellent. We postulate that the future depends on an increase in organ procurement organization activity, redesign of the national organ allocation system, and expansion of living donor activity.