While thousands await a second chance at life on the liver transplant waitlist, a record number of transplants in 2023 delivered hope, yet stark statistics reveal an urgent story of geographic disparities, high-acuity patients, and the ongoing race against time.
Key Takeaways
- As of January 4, 2024, there were 10,626 adult candidates and 629 pediatric candidates on the U.S. liver waiting list.
- In 2023, 11,734 deceased donor liver transplants were performed in the U.S., representing a 5.2% increase from 2022.
- The median wait time for liver transplant candidates with MELD score 15-20 was 4.1 months as of 2022 data.
- In 2022, 89% of deceased donor livers were recovered from brain-dead donors.
- Average donor age for liver transplants was 39.2 years in 2023.
- 14% of deceased donors for liver were DCD (donation after circulatory death) in 2023.
- In 2023, 62% of adult liver recipients were male.
- Average recipient age at liver transplant was 56.7 years in 2023.
- 35% of liver recipients had alcohol-related liver disease as primary diagnosis in 2023.
- In 2023, 11,734 deceased donor liver transplants performed in U.S.
- Living donor liver transplants totaled 361 in U.S. 2023.
- Total liver transplants increased 7% from 2022 (12,369) to 2023.
- 1-year graft survival post-liver transplant 92.5% for adults 2022 cohort.
- 5-year patient survival 75.8% after deceased donor liver transplant in 2018 cohort.
- Pediatric 1-year survival 95.2% post-liver transplant in 2022.
Despite high demand and mortality, U.S. liver transplants are increasing to meet patient needs.
Donor Pool and Characteristics
- In 2022, 89% of deceased donor livers were recovered from brain-dead donors.
- Average donor age for liver transplants was 39.2 years in 2023.
- 14% of deceased donors for liver were DCD (donation after circulatory death) in 2023.
- 42% of liver donors were blood type O in U.S. 2023 transplants.
- Donor BMI averaged 27.4 kg/m² for deceased liver donors in 2022.
- 28% of deceased liver donors had hepatitis C virus (HCV) in 2023.
- Public health service increased risk donors comprised 22% of liver donors in 2023.
- Female donors provided 41% of deceased donor livers in 2022.
- Average cold ischemia time for deceased donor livers was 6.8 hours in 2023.
- 7.2% of potential deceased donors were utilized for liver recovery in 2022.
- Donors after brain death (DBD) livers had 92% utilization rate in 2023.
- 15% of liver donors were over age 60 in U.S. 2023 data.
- Hispanic ethnicity in 19% of deceased liver donors in 2022.
- Living liver donors averaged 37.5 years old, 52% female in 2023.
- 2,283 living donor liver transplants in U.S. cumulative to 2023, mostly to adults.
- Donor steatosis >30% discarded 12% of offered livers in 2022.
- Black race in 13% of deceased liver donors in 2023.
- DCD donor livers had 8.5% primary non-function rate vs 2.1% DBD in 2022.
- 65% of living donors were biologically related to recipients in 2023.
- Average donor height 174 cm for liver donors in 2023.
- 9% of deceased donors had history of diabetes for liver recovery in 2022.
- Pediatric donors (<18 years) provided 4% of livers in 2023.
- 31% of liver donors had cause of death trauma in 2022.
- Living donor complication rate was 25% within 90 days post-donation in 2023.
- 18% discard rate for deceased donor livers due to steatosis in 2022.
- Asian donors 6% of total liver donors in U.S. 2023.
- Average warm ischemia time in DCD livers was 25 minutes in 2023.
- 82% of liver grafts from donors under 50 years in 2022.
Donor Pool and Characteristics Interpretation
These statistics reveal a field pulling livers from younger, heavier, and increasingly diverse sources, then rushing them into recipients with remarkable efficiency, all while navigating a tightrope of risk, scarcity, and the constant hope that a fatty or infected organ can still be the gift of life.
Recipient Profiles
- In 2023, 62% of adult liver recipients were male.
- Average recipient age at liver transplant was 56.7 years in 2023.
- 35% of liver recipients had alcohol-related liver disease as primary diagnosis in 2023.
- 29% of adult liver recipients were blood type O in 2022.
- BMI average 28.9 kg/m² for liver recipients in 2023.
- 24% of liver recipients had hepatocellular carcinoma in 2023.
- 16% of recipients were Hispanic ethnicity in U.S. liver transplants 2022.
- 72% of pediatric liver recipients were under 12 years old in 2023.
- 18% of adult recipients had prior liver transplant (retransplant) in 2022.
- Dialysis pretransplant in 22% of liver recipients in 2023.
- 13% Black race among adult liver recipients in 2023.
- Hepatitis C primary diagnosis in 11% of new liver recipients 2023.
- 41% female adult liver recipients in 2022.
- MELD score average 25.3 at time of liver transplant in 2023.
- 9% of recipients had acute liver failure diagnosis in 2022.
- 27% of recipients had diabetes pretransplant in 2023.
- Pediatric recipients 2% of total liver transplants in 2023 (318 cases).
- 34% of recipients had portal vein thrombosis pretransplant in 2022.
- Asian recipients 5% of total in U.S. 2023 liver transplants.
- 15% of recipients over age 65 in 2023.
- 23% had mechanical ventilation pretransplant in 2022 high-acuity cases.
- Non-alcoholic steatohepatitis (NASH) in 32% of recipients 2023.
- 7% pediatric recipients from living donors in 2023.
- 19% recipients with BMI >30 kg/m² in 2022.
- White race 68% of liver recipients in 2023.
- 12% had ICU stay pretransplant in elective recipients 2023.
- Primary biliary cholangitis in 3% of female recipients 2022.
Recipient Profiles Interpretation
The portrait of a modern liver recipient is most often a man in his late fifties, statistically likely to be white and carrying the heavy burden of alcohol, obesity, or a failing first graft, with a disease severe enough to earn a critical MELD score, yet still part of a system where children and minorities remain starkly underrepresented.
Survival and Outcomes
- 1-year graft survival post-liver transplant 92.5% for adults 2022 cohort.
- 5-year patient survival 75.8% after deceased donor liver transplant in 2018 cohort.
- Pediatric 1-year survival 95.2% post-liver transplant in 2022.
- 3-month graft failure rate 4.2% for DCD livers vs 2.1% DBD in 2023.
- Living donor recipient 1-year survival 95.1% in 2023 data.
- 10-year survival 54.3% for adult liver recipients transplanted 2013.
- Acute rejection incidence 15% within 1 year post-liver transplant 2022.
- Conditional 1-year survival post-90 days 96.8% for livers in 2023.
- Biliary complications in 20.5% of recipients at 1 year 2022.
- Retransplant patient survival 1-year 85.4% in 2023 cohort.
- MELD >35 recipients had 1-year survival 82.1% in 2022.
- Infection-related mortality 8% within 1 year post-transplant 2023.
- 90-day mortality 5.6% for adult liver transplants in 2023.
- HCV-positive donor to negative recipient 1-year survival 93.2% 2023.
- Pediatric living donor 5-year survival 91.7% as of 2022 data.
- Vascular thrombosis complication 4.8% at 1 year post-liver TX 2023.
- Overall U.S. liver graft half-life 14.5 years per 2022 analysis.
- 1-year survival for SLK 90.1% in 2023 transplants.
- Chronic rejection 3.2% incidence by 5 years post-transplant 2022.
- NASH recipients 3-year survival 78.4% in 2020 cohort.
Survival and Outcomes Interpretation
It's a nuanced balancing act where the liver transplant's remarkable first-year success stories give a standing ovation to modern medicine, yet the persistent chorus of complications and declining long-term survival rates humbly reminds the audience that this life-saving encore is still a grueling marathon, not a sprint.
Transplant Volumes and Trends
- In 2023, 11,734 deceased donor liver transplants performed in U.S.
- Living donor liver transplants totaled 361 in U.S. 2023.
- Total liver transplants increased 7% from 2022 (12,369) to 2023.
- Split liver transplants numbered 116 in 2023.
- Pediatric liver transplants 318 in 2023, up 4% from prior year.
- 1,676 liver transplants from HCV-viremic donors in 2023.
- National transplant rate for liver waiting list reached 30.2 per 100 PY in 2023.
- Simultaneous liver-kidney transplants 882 in 2023.
- Liver transplant volume per center averaged 28.4 in 2022 high-volume centers.
- Global liver transplants estimated 30,000 annually as of 2022 WHO data.
- U.S. liver transplants per million population 36.1 in 2023.
- Retransplants 8% of total liver procedures in 2023 (1,056 cases).
- DCD liver transplants 1,118 in 2023.
- Liver transplant trends show 150% increase since 2000 in U.S.
- 45 centers performed >30 liver transplants in 2023.
- Europe performed ~6,000 liver transplants in 2022 per Eurotransplant.
- Living donor proportion 3.5% of total U.S. liver transplants 2023.
- Monthly liver transplants averaged 977 in U.S. 2023.
- 12% increase in SLK transplants from 2022 to 2023.
- Pediatric split livers 52 in 2023.
Transplant Volumes and Trends Interpretation
While the soaring number of transplants paints a hopeful picture, the staggering reliance on deceased donors—with living ones making up a mere 3.5%—reveals a sobering gap between our surgical success and our communal generosity.
Waiting List and Demand
- As of January 4, 2024, there were 10,626 adult candidates and 629 pediatric candidates on the U.S. liver waiting list.
- In 2023, 11,734 deceased donor liver transplants were performed in the U.S., representing a 5.2% increase from 2022.
- The median wait time for liver transplant candidates with MELD score 15-20 was 4.1 months as of 2022 data.
- 17% of adult liver waiting list candidates were status 1A in 2023, indicating highest urgency.
- Pediatric liver waiting list had 629 candidates in early 2024, with 12% under age 1 year.
- Liver waiting list mortality rate was 12.5 per 100 patient-years for adults in 2022.
- 2,169 patients were removed from liver waiting list due to death or too sick in 2023.
- MELD score at listing averaged 22.4 for adult liver candidates in 2022.
- 41% of liver waiting list additions in 2023 had hepatocellular carcinoma diagnosis.
- Geographic disparities show Region 11 had highest liver waitlist mortality at 18.2 per 100 PY in 2022.
- 8,863 new adult patients added to liver waiting list in 2023.
- Pretransplant mortality for pediatric liver candidates was 7.8% in 2022.
- 25% of liver candidates waitlisted in 2023 were blood type O.
- Liver waitlist removals for transplantation increased 6% from 2022 to 2023.
- Average days on waitlist for liver transplant was 187 for adults in 2022.
- 1,345 pediatric liver transplants performed cumulatively since 1988 as of 2023.
- 35% of waitlisted liver patients had alcohol-related liver disease in 2023.
- Status 6 (inactive) comprised 15% of adult liver waiting list in 2023.
- Liver waiting list grew by 4.2% from 2022 to 2023 end-of-year.
- 22% of new liver listings were for acute liver failure in 2022.
- Median MELD at transplant for deceased donor livers was 28.1 in 2023.
- 9.3% of liver candidates died within 3 months of listing in 2022.
- Pediatric waitlist time median was 49 days for status 1A in 2023.
- 47% of liver waitlist had portal hypertensive bleeding history in 2023.
- Liver transplant waitlist candidates with BMI >35 comprised 18% in 2022.
- 3,212 patients removed from liver list for condition improved in 2023.
- Regional variation: Northeast had 11.2% waitlist mortality rate in 2022.
- 62% of adult liver candidates were male on waitlist in 2023.
- Hepatitis C etiology dropped to 12% of new liver listings in 2023.
- 1,112 living donor liver transplants performed since 1989 as cumulative pediatric data to 2023.
Waiting List and Demand Interpretation
The sobering reality behind these numbers is a tragic race where over ten thousand lives queue for a rescue that, despite a record year of transplants, still sees thousands removed from the list because they died or became too sick while waiting.