While the thought of a liver transplant can feel daunting, modern medicine has transformed it into a remarkably successful journey, boasting a one-year survival rate of over 93% thanks to decades of refinement.
Key Takeaways
- The 1-year patient survival rate after liver transplantation in the US from 2000-2022 is 93.4%
- Overall 5-year patient survival for liver transplants performed between 2015-2020 is 82.1% according to SRTR data
- Kaplan-Meier estimated median patient survival post-liver transplant is 15.2 years for recipients transplanted in 2018
- Perioperative (30-day) patient survival after liver transplant is 98.2% in 2022 OPTN reports
- 6-month graft survival rate for liver transplants is 91.5% in adults (2018-2022)
- 1-year patient survival for living donor liver transplants is 94.1% vs 92.8% deceased donor
- 5-year patient survival for primary liver transplants is 78.6% (SE 0.4%)
- 10-year graft survival rate post-liver transplant is 54.2% in US adults
- Median survival post-transplant for alcoholic liver disease is 12.8 years
- Age >60 years increases mortality risk post-transplant (HR 1.45, 95% CI 1.32-1.59)
- MELD score >25 at transplant correlates with 1-year mortality OR 2.1 (95% CI 1.8-2.4)
- Donor age >70 reduces 5-year graft survival to 68.3% (p<0.001)
- Survival in Black recipients is 88.2% at 1-year vs 93.5% White (HR 1.35)
- Living donor LT survival exceeds deceased by 4.2% at 5 years (92.1% vs 87.9%)
- Pediatric vs adult 1-year survival: 95.8% vs 92.4% (p=0.002)
Liver transplant patients now have excellent short-term and steadily improving long-term survival.
Comparative Survival
- Survival in Black recipients is 88.2% at 1-year vs 93.5% White (HR 1.35)
- Living donor LT survival exceeds deceased by 4.2% at 5 years (92.1% vs 87.9%)
- Pediatric vs adult 1-year survival: 95.8% vs 92.4% (p=0.002)
- NASH vs HCV 5-year survival: 80.3% vs 82.7% (adjusted HR 1.05)
- Retransplant 1-year survival 82.6% vs primary 93.1%
- High-volume center survival 94.2% 1-year vs low-volume 89.7%
- DCD donor grafts 1-year survival 88.5% vs DBD 92.3% (HR 1.28)
- Male vs female donor survival equivalence (92.8% vs 92.5% 1-year)
- ALD vs PSC 10-year survival 58.4% vs 72.1%
- Pre-transplant LT vs no LT for HCC: 5-year 75.2% vs 12.5%
- Hispanic recipients 1-year survival 91.5% vs Asian 95.2% (HR 1.22)
- LDLT vs DDLT 10-year survival 68.7% vs 60.3%
- Infant vs adolescent pediatric survival 96.2% vs 93.4% 1-year
- ALD vs viral hepatitis 5-year 79.8% vs 81.4% (NS)
- Second LT survival 78.9% 1-year vs first 93.4%
- Volume >100/yr centers 1-year 94.8% vs <20 88.9%
- ECD donors 1-year graft 86.2% vs standard 93.7%
- Female donor to male recipient survival 91.9% vs match 93.2%
- PSC vs AIH 10-year 74.3% vs 69.8%
- LT vs resection HCC 5-year 72.1% vs 55.4%
Comparative Survival Interpretation
The statistics reveal a transplant landscape where the odds of survival are shaped by a mosaic of factors—from the undeniable impact of racial disparities and center expertise to the type of donor organ and underlying disease—reminding us that while the gift of life is universal, the pathways to securing it are marked by complex and often unequal terrain.
Long-term Survival
- 5-year patient survival for primary liver transplants is 78.6% (SE 0.4%)
- 10-year graft survival rate post-liver transplant is 54.2% in US adults
- Median survival post-transplant for alcoholic liver disease is 12.8 years
- 5-year conditional survival (beyond 1-year) is 84.3% for liver recipients
- 20-year patient survival after pediatric liver transplant is 68.1%
- Long-term (15-year) graft survival for living donor recipients is 61.7%
- 7-year survival in NASH cirrhosis post-transplant is 72.4% (95% CI 70-75%)
- Decade-long survival (10-year) for retransplants is 45.6% vs 65.2% primary
- 5-year survival for elderly (>65) recipients is 74.9%
- Lifetime survival post-liver transplant averages 18.4 years in low-risk groups
- 5-year patient survival 2020 cohort 81.2%
- 10-year graft survival 53.8% US registry
- Median survival NASH 11.5 years post-LT
- 5-year survival given 1-year survival 85.1%
- 25-year pediatric survival 60.4%
- 12-year LDLT graft survival 64.2%
- PBC post-LT 8-year survival 76.5%
- Retransplant 5-year survival 52.3%
- >70yo 5-year survival 71.2%
- Low-risk median survival 20.1 years
Long-term Survival Interpretation
While liver transplantation offers a robust second act, with over three-quarters of patients thriving at five years, it's a long-term commitment where the script can rewrite itself, as evidenced by the decade-plus median survivals and the sobering gap between initial success and long-term graft survival.
Overall Survival
- The 1-year patient survival rate after liver transplantation in the US from 2000-2022 is 93.4%
- Overall 5-year patient survival for liver transplants performed between 2015-2020 is 82.1% according to SRTR data
- Kaplan-Meier estimated median patient survival post-liver transplant is 15.2 years for recipients transplanted in 2018
- Crude 90-day patient survival rate post-liver transplant is 96.8% in adults from 2010-2019
- Adjusted 3-year patient survival for deceased donor liver transplants is 85.7% (HR 1.0 reference)
- Overall graft survival at 1 year post-liver transplant in Europe (ELTR) is 89.2% for transplants 2010-2021
- Patient survival at discharge post-liver transplant is 97.5% in high-volume centers
- Long-term overall survival (10-year) for liver transplant recipients is 62.4%
- Overall conditional survival at 5 years post-transplant improves to 78.9% for those surviving first year
- US national average 1-year survival post-orthotopic liver transplant is 92.9% (2021 data)
- The 1-year patient survival rate for adult liver transplants in 2022 was 93.1% (n=8900)
- Overall 3-year graft survival post-liver transplant is 82.4% per 2021 SRTR
- Median overall survival for OLT recipients 2010-2020 is 14.7 years
- 180-day patient survival rate is 95.2% nationally
- Adjusted 1-year survival for LDLT is 95.0% (reference DDLT 93.4%)
- ELTR registry shows 1-year patient survival 91.8% 2005-2020
- Survival to 1-year post-transplant in top centers 97.3%
- 12-year overall patient survival is 55.6%
- Conditional 3-year survival post-1-year survival is 87.2%
- 2022 US 1-year survival average 93.6% for 9,200 procedures
Overall Survival Interpretation
While the initial transplant survival odds are excellent, the long-term reality reveals it's a bit like buying a very reliable car—you can confidently drive it home from the dealership, but you'll likely need to start thinking about a new engine well before the 15-year mark.
Risk Factors and Outcomes
- Age >60 years increases mortality risk post-transplant (HR 1.45, 95% CI 1.32-1.59)
- MELD score >25 at transplant correlates with 1-year mortality OR 2.1 (95% CI 1.8-2.4)
- Donor age >70 reduces 5-year graft survival to 68.3% (p<0.001)
- Female recipients have 10% higher rejection risk (HR 1.12, CI 1.05-1.20)
- BMI >35 pre-transplant decreases 3-year survival to 76.2% (adjusted HR 1.38)
- HCV recurrence post-transplant worsens 5-year survival to 70.1% pre-DAA era
- Diabetes mellitus increases graft loss risk (HR 1.29, 95% CI 1.15-1.44)
- Cold ischemia time >12 hours reduces 1-year survival by 15% (OR 1.62)
- Portal hypertension HR 1.52 for mortality (CI 1.41-1.64)
- Creatinine >2.0 mg/dL HR 2.34 for 90-day mortality
- Steatotic donor liver 5-year survival drop to 75.4%
- ABO incompatible LT rejection HR 1.45 (CI 1.22-1.72)
- Sarcopenia reduces 3-year survival to 73.8% (HR 1.41)
- Post-LT CMV infection HR 1.33 for graft loss
- WIT >60 min survival reduction OR 1.78
Risk Factors and Outcomes Interpretation
When selecting a liver transplant candidate, it is essentially a perilous mathematical game where being older, sicker, heavier, more sarcopenic, diabetic, or a woman, and receiving a liver that is older, fattier, ischemic, or mismatched, each add their own distinct and often compounding tax on the slim chances of survival one is already desperately bargaining for.
Short-term Survival
- Perioperative (30-day) patient survival after liver transplant is 98.2% in 2022 OPTN reports
- 6-month graft survival rate for liver transplants is 91.5% in adults (2018-2022)
- 1-year patient survival for living donor liver transplants is 94.1% vs 92.8% deceased donor
- 90-day survival post-transplant for acute liver failure patients is 88.7%
- In-hospital mortality post-liver transplant is 2.3% (95% CI 1.9-2.7%) from 2015-2020
- 1-year graft survival for pediatric liver transplants is 95.3%
- Early (3-month) patient survival in HCV-positive recipients is 93.2%
- 1-year survival rate post-liver transplant in MELD >30 patients is 89.4%
- 30-day readmission-adjusted survival is 97.1% for liver recipients
- Short-term (1-year) survival for split-liver transplants is 91.8%
- 60-day survival post-LT is 97.8% (2020-2023 data)
- 1-year graft survival LDLT 94.8% (n=1500)
- 1-year patient survival acute fulminant hepatitis 87.5%
- 100-day survival post-LT 94.6% in cirrhotics
- Post-op mortality 1.8% within 90 days (2016-2021)
- Pediatric 1-year graft survival 94.9%
- HBV recipients 1-year survival 94.3%
- High MELD 1-year survival 87.9%
- 1-year survival post-SLT 90.5%
- 45-day survival 98.0% in elective cases
Short-term Survival Interpretation
These statistics reveal the remarkable success of modern liver transplantation, where even the "worst" survival rates represent a lifesaving triumph over conditions that were once almost universally fatal.
Sources & References
- Reference 1OPTNoptn.transplant.hrsa.govVisit source
- Reference 2SRTRsrtr.transplant.hrsa.govVisit source
- Reference 3PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 4UNOSunos.orgVisit source
- Reference 5ELTReltr.orgVisit source
- Reference 6JAMANETWORKjamanetwork.comVisit source
- Reference 7NCBIncbi.nlm.nih.govVisit source
- Reference 8HEPATITISCENTRALhepatitiscentral.comVisit source
- Reference 9GASTROJOURNALgastrojournal.orgVisit source
- Reference 10NEJMnejm.orgVisit source
- Reference 11HEPATOLOGYhepatology.theagsjournals.orgVisit source
- Reference 12AASLDPUBSaasldpubs.onlinelibrary.wiley.comVisit source