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Increasing liver transplantation waiting list mortality: a report from the Australian National Liver Transplantation Unit, Sydney

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Abstract Background: 

We aimed to describe the demand for liver transplantation (LTx) and patient outcomes on the waiting list at the Australian National Liver Transplantation Unit, Sydney over the last 20 years. Methods: 

We performed a retrospective analysis with the data divided into three eras: 1985–1993, 1994–2000 and 2001–2008. Results: 

The number of patients accepted for LTx increased from 320 to 372 and 548 (P < 0.001) with the number of LTx being performed increasing from 262 to 312 and 452 respectively (P < 0.001). The median adult recipient age increased from 45 to 48 and 52 years (P < 0.001) while it decreased in children from 4 to 2 and 1 years respectively (P= 0.001). In parallel, the deceased donor offers decreased from 1003 to 720 and 717 (P < 0.001). Methods to improve access to donor livers have been used with the use of split livers, extended criteria and non-heart beating donors, resulting in increased acceptance of deceased donor offers by 65% and 115% in the second and third eras when compared with the first era (P < 0.001). However, the adult median waiting time has increased from 23 to 41 and 120 days respectively (P < 0.001). This was associated with increased adult mortality on the waiting list from 23 to 40 and 122 respectively (P < 0.001). Conclusions: 

Despite the increasing proportion of donor offers being used, the waiting list mortality is increasing. A solution to this problem is an increase in organ donation to keep pace with the escalating demand for LTx.
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Keywords: liver transplantation; organ donation; organ donor; waiting list mortality

Document Type: Research Article

Affiliations: 1: Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital 2: Departments of Neurosurgery 3: AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital 4: The Children's Hospital at Westmead, Sydney, New South Wales, Australia 5: Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital

Publication date: September 1, 2010

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