While only about 5% of the over 212,000 liver transplants performed in the US since 1988 have come from living donors, this brave and growing act of generosity is giving more patients a crucial second chance at life.
Key Takeaways
- In the United States, from 1988 to 2022, a total of 212,656 liver transplants have been performed, with living donor liver transplants accounting for approximately 5% of all cases.
- As of 2022, living donor liver transplants in the US numbered 5,769 cumulatively since 1989, representing a small but growing portion of total liver transplants.
- In 2022, 632 living donor liver transplants were performed in the US, a 5% increase from 2021.
- In 2022, deceased donor liver transplants in the US reached 8,161, up 4% from prior year.
- From 1988-2022, 206,887 deceased donor liver transplants performed in US.
- Split liver transplants from deceased donors accounted for 1.2% of all in 2022 (98 cases).
- As of January 2023, 10,996 adults on US liver waitlist.
- New adult liver waitlist registrations: 13,768 in 2022.
- Top indications for liver transplant: 45% NASH, 25% ALC, 15% HCC in 2022 US.
- 1-year patient survival post-liver transplant: 92.5% in US 2022.
- 5-year survival for liver recipients: 75.8% adults, 85% pediatrics.
- HCC recipients 5-year survival: 72% post-transplant.
- US active adult liver waitlist averaged 11,200 in 2022, removals 15,500.
- Acuity circles policy since 2023 prioritizes local high-acuity patients, reducing transport time.
- Liver allocation radius expanded to 150-250nm under new policy.
Living donor transplants remain rare but save lives with excellent success rates.
Access and Policy
- US active adult liver waitlist averaged 11,200 in 2022, removals 15,500.
- Acuity circles policy since 2023 prioritizes local high-acuity patients, reducing transport time.
- Liver allocation radius expanded to 150-250nm under new policy.
- MELD 3.0 scoring implemented Dec 2022, incorporates sex, albumin, Na.
- Status 1A exceptions for acute liver failure: 1,200 listings/year.
- OPO median livers transplanted per donor: 1.5 nationally.
- HoPE Act enables xenotransplants, first pig-to-human liver trial 2024.
- Public awareness campaigns boost consent rates to 60% in US.
- Cost of liver tx: $878,000 first year, $30k/year maintenance.
- Global shortage: 1 million need tx yearly, only 30k performed.
- US OPTN monitors 58 OPOs, 300+ tx centers.
- Exception points for HCC: 28/34/40 MELD equiv at 6/12/18 months wait.
- Discard rate for recovered livers: 5.3% in 2022.
- International trends: China 20k tx/year, India 3k.
- COVID-19 reduced donations 20% in 2020, recovered 2022.
- State donor registries: 60% US adults registered.
- UNOS MatchRun software allocates 100k offers/year.
Access and Policy Interpretation
While the liver transplant system is performing logistical heroics with 15,500 annual removals against an 11,200-person waitlist, this efficiency is a damning testament to a global math problem where a million need saving and only 30,000 get the call.
Deceased Liver Donation
- In 2022, deceased donor liver transplants in the US reached 8,161, up 4% from prior year.
- From 1988-2022, 206,887 deceased donor liver transplants performed in US.
- Split liver transplants from deceased donors accounted for 1.2% of all in 2022 (98 cases).
- DCD (donation after circulatory death) livers comprised 2.5% of US deceased donor transplants in 2022 (204 cases).
- Average deceased donor age for liver donation in US is 41 years, with 60% male.
- Hepatitis C positive deceased donors increased to 25% of US liver donors in 2022 due to DAAs.
- Nationally recovered deceased liver donors in 2022: 8,619, utilization rate 94.7%.
- Pediatric deceased donor livers (age <18) numbered 48 in US 2022, mostly to children.
- Extended criteria donors (ECD) livers, including steatotic, used in 30% of transplants.
- In Europe, Eurotransplant facilitated 1,800 deceased liver donations in 2022.
- UK deceased liver donors: 1,000 in 2022/23, with DCD at 40%.
- Deceased donor liver cold ischemia time averages 6.5 hours in US.
- Maquet machine perfusion preserved 85% of marginal deceased livers for transplant.
- From 2010-2020, 15% increase in US deceased donors over 70 years old.
- Donation after brain death (DBD) accounts for 97% of US deceased liver donations.
- Hispanic deceased donors rose to 19% of US total in 2022.
- OPO performance varies: top OPOs recover 50 livers/100 donors.
- Normothermic regional perfusion (NRP) boosted DCD liver utilization by 20% in Spain.
- US deceased liver donor BMI average 28.5, with 35% obese.
- In 2022, 92 livers discarded post-recovery due to high steatosis (>30%).
- Transplant rate from deceased donors on waitlist: 25 per 100 patient-years in 2022.
- 1-year graft survival from deceased donors: 89.2% in US adults.
Deceased Liver Donation Interpretation
The cold, hard numbers tell a relentlessly hopeful story: while we honor the profound generosity of over 200,000 deceased donors since 1988, the field's cleverness in using once-discarded livers and pushing utilization to 95% proves that every precious gift is being squeezed for every possible drop of life.
Living Liver Donation
- In the United States, from 1988 to 2022, a total of 212,656 liver transplants have been performed, with living donor liver transplants accounting for approximately 5% of all cases.
- As of 2022, living donor liver transplants in the US numbered 5,769 cumulatively since 1989, representing a small but growing portion of total liver transplants.
- In 2022, 632 living donor liver transplants were performed in the US, a 5% increase from 2021.
- Living liver donors are predominantly aged 30-50 years, with 58% female donors in the US from 2010-2020.
- The most common living donor liver graft is the right lobe, used in 65% of adult-to-adult living donor transplants in the US.
- Post-donation, 0.2-0.5% of living liver donors experience major complications like bile leak or hepatic artery thrombosis.
- Living donor liver transplantation (LDLT) has a donor mortality risk of about 0.1-0.3% in high-volume centers.
- In Asia, Japan leads with over 5,000 LDLTs performed since 1990, mostly right lobe grafts.
- Pediatric LDLT from parents shows 90% graft survival at 5 years in Europe.
- US living donors undergo extensive evaluation, with 20-30% deemed ineligible due to steatosis or anatomy.
- From 2002-2018, 4,318 LDLTs in US adults had 78.5% 5-year recipient survival.
- Female living donors have higher donation rates (52%) in US, but higher biliary complication risk post-donation.
- LDLT waitlist mortality is reduced by 50% compared to deceased donor list for children.
- In 2021, 741 living liver donor recoveries occurred, with average hospital stay of 5.7 days.
- ABO-incompatible LDLT success rates exceed 85% with modern immunosuppression.
- Living donor programs in US expanded post-2002, with peak of 524 LDLTs in 2006.
- Donor liver remnant volume must be at least 30-35% for safe adult LDLT donation.
- Long-term donor quality of life post-LDLT is comparable to general population, with 92% reporting no regrets.
- In India, over 2,000 LDLTs performed annually, driven by high end-stage liver disease prevalence.
- Split-liver from living donors is rare, <1% of LDLTs, mainly for pediatric use.
- LDLT donor selection excludes those with BMI >35, reducing fatty liver risk.
- 5-year donor survival post-LDLT is 95.8% vs 97.1% in matched controls.
- In Europe, ELTR reports 1,200 pediatric LDLTs with 89% 10-year survival.
- US LDLT centers must perform >10/year for OPTN certification.
- Domino LDLT using grafts from familial amyloidosis patients performed in 150 cases worldwide.
- Post-LDLT, donors have 10-20% reduced liver function initially, recovering in 6 months.
- LDLT graft survival at 1 year is 85-90% in experienced centers.
- Female-to-male LDLT has higher small-for-size syndrome risk (15%).
- Insurance covers LDLT donor costs in 95% of US cases via living donor protection acts.
- Global LDLT volume: Asia 80%, US/Europe 20% of total living donations.
Living Liver Donation Interpretation
While living donors bravely contribute a vital 5% of all liver transplants—primarily as women in their prime giving their right lobe with a mortality risk barely over a tenth of a percent—their impact is profound, slashing pediatric waitlist deaths in half and achieving survival rates that honor their extraordinary gift.
Recipient Statistics
- As of January 2023, 10,996 adults on US liver waitlist.
- New adult liver waitlist registrations: 13,768 in 2022.
- Top indications for liver transplant: 45% NASH, 25% ALC, 15% HCC in 2022 US.
- Pediatric waitlist: 579 children as of 2023, median wait 5 months.
- MELD score at transplant averages 24.5 for US adults.
- 40% of US liver recipients are status 1A (acute failure) at listing.
- Female recipients: 42% of US liver transplants.
- HCC exception points granted to 20% of waitlisted adults.
- Simultaneous liver-kidney (SLK) transplants: 472 in 2022 US.
- Age distribution: 30% recipients >65 years in 2022.
- African American recipients: 13% of liver transplants, higher waitlist mortality.
- Retransplant rate within 1 year: 4.5% for liver.
- Pre-transplant dialysis in 25% of liver candidates.
- Geographic disparity: Region 11 has longest median wait 14 months.
- 15% of waitlisted patients die or become too sick annually.
- Insurance: 60% Medicare, 30% private for recipients.
- BMI >35 in 28% of adult recipients.
- Viral hepatitis C recipients dropped to 10% in 2022 post-DAA.
- Pediatric recipients: 85% biliary atresia diagnosis.
- Multi-organ recipients: 5% of liver cases.
Recipient Statistics Interpretation
Despite the laudable and urgent effort to save lives with liver transplants, the sobering reality is that the American system is being drained by a tsunami of chronic, preventable diseases like fatty liver disease, while a child's chance for timely survival depends heavily on the accident of their zip code.
Survival and Outcomes
- 1-year patient survival post-liver transplant: 92.5% in US 2022.
- 5-year survival for liver recipients: 75.8% adults, 85% pediatrics.
- HCC recipients 5-year survival: 72% post-transplant.
- Primary non-function rate: 2-5% for liver grafts.
- Chronic rejection incidence: 3-5% at 5 years.
- Biliary complications: 20-30% within 1 year post-transplant.
- 10-year survival: 58% for deceased donor liver recipients.
- NASH recipients have 68% 5-year survival, lower due to comorbidities.
- Pediatric 20-year survival: 75% post-liver transplant.
- SLK 1-year survival: 82% vs 90% liver alone.
- Acute rejection: 15-20% in first year, steroids responsive 90%.
- CMV infection post-transplant: 20-30%, prophylaxis reduces to 10%.
- Recurrence of HCC: 15% at 5 years.
- Graft half-life: 12 years for liver transplants.
- Post-transplant lymphoproliferative disorder: 2-4% incidence.
- Renal failure post-liver tx: 20% at 5 years, CNI toxicity main cause.
- Quality-adjusted life years (QALYs) gained: 8.5 per liver transplant.
- LDLT vs DDLT 3-year survival equivalent: 82% both.
- MELD >35 survival at 3 months pre-tx: 50%.
- 90-day mortality post-tx: 7.2% for high MELD.
- In EU, Eurotransplant 1-year survival 90.5%.
- Global 1-year liver tx survival: 85-90% in high-income countries.
Survival and Outcomes Interpretation
The statistics show that receiving a liver transplant is a resounding wager for a second chance, though the journey is a marathon with predictable hurdles—from biliary complications to rejection—where surviving the first year with a 92.5% chance is the impressive opening act, but the real victory is in the decades of life reclaimed, especially for children who can look forward to a 75% chance at a 20-year encore.
Sources & References
- Reference 1OPTNoptn.transplant.hrsa.govVisit source
- Reference 2UNOSunos.orgVisit source
- Reference 3SRTRsrtr.transplant.hrsa.govVisit source
- Reference 4PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 5NCBIncbi.nlm.nih.govVisit source
- Reference 6ATSJOURNALSatsjournals.orgVisit source
- Reference 7TRANSPLANTJOURNALtransplantjournal.comVisit source
- Reference 8JSTjst.gr.jpVisit source
- Reference 9ELTReltr.orgVisit source
- Reference 10MAYOCLINICmayoclinic.orgVisit source
- Reference 11AJTRANSPLANTajtransplant.orgVisit source
- Reference 12PEDIATRICSpediatrics.aappublications.orgVisit source
- Reference 13RADIOLOGYASSISTANTradiologyassistant.nlVisit source
- Reference 14ILTSilts.orgVisit source
- Reference 15NATUREnature.comVisit source
- Reference 16UPTODATEuptodate.comVisit source
- Reference 17JAMANETWORKjamanetwork.comVisit source
- Reference 18HEPJOURNALhepjournal.comVisit source
- Reference 19ISHLTishlt.orgVisit source
- Reference 20KIDNEYkidney.orgVisit source
- Reference 21FRONTIERSINfrontiersin.orgVisit source
- Reference 22EUROTRANSPLANTeurotransplant.orgVisit source
- Reference 23ODTodt.nhs.ukVisit source
- Reference 24CMScms.govVisit source
- Reference 25TRANSPLANTATIONJOURNALtransplantationjournal.comVisit source
- Reference 26JOURNAL-OF-HEPATOLOGYjournal-of-hepatology.euVisit source
- Reference 27AJKDajkd.orgVisit source
- Reference 28NEJMnejm.orgVisit source
- Reference 29WHOwho.intVisit source
- Reference 30DONATELIFECALIFORNIAdonatelifecalifornia.orgVisit source
- Reference 31MILLIMANmilliman.comVisit source
- Reference 32ORGANDONORorgandonor.govVisit source