THE NORDIC LIVER TRANSPLANT REGISTRY
ANNUAL REPORT 2001
This complete report is distributed to a limited number of
persons through the responsible contact persons at each centre.
Additional copies can be obtained from K. Bjøro, Oslo
Responsible contact persons:
Oslo, Inge Bjørn Brekke
Helsinki, Krister Höckerstedt
Stockholm, Bo-Göran Ericzon
Copenhagen, Preben Kirkegaard
Report prepared by Kristian Bjøro
April 2002
Nordic liver transplant registry - 2001
As of December
31st 2001 the registry
comprised data on 2392 patients of whom 2004 had received a first liver
allograft.
The registry
comprises complete data on all patients listed for liver transplantation during
the period 1990-2001; 2173 patients.
The remaining
219 patients received a liver allograft prior to 1990, waiting list data are
not available for these patients.
Transplantation
activity 2001
A total of 225
patients were listed for a first liver transplantation in 2001. Of these 159
received a first liver allograft.
Eleven of the
225 patients died while being active on the waiting list – two of these while
awaiting a second transplantation.
Fifteen were
permanently withdrawn from the waiting list without receiving a liver
allograft.
Forty patients
were active on the waiting list as of December 31st, a higher number
as compared to previous years
The total
number of patients receiving a first liver allograft during 2001 was 192 (31 patients were listed prior to
January 1st 2001),
in addition 17
retransplants (15 second
and 2 third) were performed.
The number of
first liver transplantations increased by more than 10% as compared to the
period 1996-2000.
Fulminant
hepatic failure (n=43) was the most frequent indication for being listed for a
liver transplantation,
followed by
primary sclerosing cholangitis (n=36).
Older
recipients (above 60 years of age) increased in number. During 2001, 40
patients above 60 years of age received
a first liver
allograft, comprising 21% of the total population of patients.
Median and
mean waiting times (electively listed patients) have increased to 42 and 85
days respectively.
Median waiting
time for blood type 0 recipients in 2001 was 85 days. The number of deaths on
the waiting list is unchanged.
A total of 17
patients died while waiting for a liver allograft during 2001.
Donor age has
increased steadily during the nineties, approximately 10% of the donors were
above 60 years of age.
Survival rates
following liver transplantation are still increasing and for the last 3-year
period the 1-year patient survival is above 85%.
Survival data
will strongly depend on patient selection. As
this most probably differs between the various centres,
comparison
between the five participating centres is not performed.
Maintenance of the
registry
Most centres
are as of today relatively up-to-date as concerns the completeness of data.
Very few data on number of patients,
dates of
transplantation, diagnosis and status dead/alive are lacking. In some patients, detailed data on
acceptance and
transplantation
are missing. C-forms, comprising data on follow-up, are still incomplete in
many patients.
The results
presented in this report are based on the data in the registry as of March 5th.
2002.
Acknowledgements -
financial support
The
maintenance of the software has been performed by Scandiatransplant. We greatly
acknowledge the help and support from
Niels Grunnet,
Melvin Madsen, Christian Mondrup and Frank Pedersen in Aarhus. Without their
help and support it would not
have been
possible to maintain the registry. Without the day-to-day assistance we have
received from Christian Mondrup and
Frank Pedersen
it would have been impossible to tie up a large number of loose ends and
develop the registry further.
Transplant
nurses and transplant coordinators at the individual centres have made an
enormous effort in updating and maintaining the registry.
The existence
of the registry depends completely on their work and dedication.
The registry
received financial support from Fujisawa and Novartis during 2001. This support
has been of great help.
All financial
support has been given without any obligations and the registry has no
commitments to any pharmaceutical company.
Organisation and data
ownership
It should be
emphasised that the registry (software) is the property of Scandiatransplant
while the data in the registry is the property
of the Nordic
Liver Transplantation Group. Utilisation of data should be censored by the
latter. The data presented here should not be
used without
permission from the Nordic Liver Transplantation Group. The contact persons
from each centre are the following:
Copenhagen Preben Kirkegaard
Gothenburg Styrbjörn Friman
Helsinki Krister Höckerstedt
Oslo Inge
Bjørn Brekke
Stockholm Bo-Göran Ericzon
Oslo April
2002 Kristian Bjøro
NB
Patients listed and
receiving liver allografts in Uppsala prior to 2000 are recorded as
Stockholm-patients.
Kristian
Bjøro,
Section for
Gastroenterology and Hepatology
National
Hospital, 0027 Oslo, Norway
ACTIVITY 2001
Activity
during 2001 – total number of transplantations, first transplantations,
retransplantations, deaths on waiting list and
permanent
withdrawals – irrespective of when the patients were listed
|
|
Total tx |
First liver tx |
ReTx |
DEA |
PW |
|
|
CDT |
LDT |
|||||
|
København |
32 |
26 |
0 |
6 |
3 |
3 |
|
Göteborg |
54 |
46 |
4 |
4 |
4 |
8 |
|
Helsinki |
38 |
37 |
0 |
1 |
4 |
6 |
|
Oslo |
37 |
31 |
1 |
5 |
5 |
2 |
|
Stockholm |
47 |
43 |
3 |
1 |
1 |
1 |
|
Uppsala |
1 |
1 |
0 |
0 |
0 |
0 |
|
Total |
209 |
184 |
8 |
17 |
17* |
20 |
Duration of time on
waiting list, patients receiving 1. liver allograft 1996-2001 (excluding urgent
listings)
|
|
2001 |
2000 |
1999 |
1998 |
1997 |
1996 |
|
median
(days) |
42 |
43 |
30 |
21 |
23 |
27 |
|
mean (days) |
85 |
75 |
55 |
53 |
63 |
64 |
Annual total number
of liver transplantations, 1996-2001
|
|
2001 |
2000 |
1999 |
1998 |
1997 |
1996 |
|
Tx no 1 |
192 |
169 |
164 |
175 |
161 |
141 |
|
Tx no 2 |
15 |
19 |
16 |
28 |
17 |
20 |
|
Tx no 3 |
2 |
3 |
3 |
1 |
0 |
5 |
|
Tx no 4 |
0 |
0 |
0 |
0 |
0 |
2 |
|
|
209 |
191 |
183 |
204 |
178 |
168 |
Number of liver
transplantations per centre, 1996-2001
|
|
1.liver transplantations |
Retransplantations* |
||||||||||
|
|
2001 |
2000 |
1999 |
1998 |
1997 |
1996 |
2001 |
2000 |
1999 |
1998 |
1997 |
1996 |
|
Copenhagen |
26 |
20 |
26 |
28 |
37 |
35 |
6 |
4 |
5 |
6 |
2 |
9 |
|
Gothenburg |
50 |
40 |
41 |
54 |
46 |
39 |
4 |
8 |
5 |
5 |
3 |
4 |
|
Helsinki |
37 |
28 |
28 |
33 |
23 |
23 |
1 |
3 |
2 |
6 |
5 |
6 |
|
Oslo |
32 |
25 |
23 |
19 |
16 |
15 |
5 |
5 |
5 |
6 |
2 |
6 |
|
Stockholm |
46 |
56 |
46 |
41 |
39 |
29 |
1 |
2 |
1 |
6 |
5 |
3 |
|
Uppsala |
1 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
192 |
169 |
164 |
175 |
161 |
141 |
17 |
22 |
18 |
29 |
17 |
26 |
* includes all
retransplants - second, third and fourth
Diagnoses of patients receiving a first liver transplant 1996-2001
|
|
2001 |
2000 |
1999 |
1998 |
1997 |
1996 |
|
Primary
sclerosing cholangitis |
37 |
28 |
21 |
24 |
31 |
25 |
|
Acute
hepatic failure |
33 |
16 |
20 |
18 |
24 |
15 |
|
Hepatitis C
cirrhosis |
10 |
16 |
17 |
17 |
11 |
5 |
|
Primary
biliary cirrhosis |
10 |
18 |
16 |
16 |
14 |
13 |
|
Metabolic
diseases |
9 |
11 |
14 |
15 |
6 |
6 |
|
Alcoholic
cirrhosis |
21 |
21 |
13 |
28 |
21 |
14 |
|
Malignant
diseases |
15 |
17 |
12 |
19 |
9 |
5 |
|
Autoimmune
cirrhosis |
5 |
6 |
10 |
1 |
5 |
9 |
|
Biliary
atresia |
11 |
7 |
9 |
8 |
3 |
9 |
|
Hepatitis B
cirrhosis |
4 |
6 |
7 |
5 |
5 |
4 |
|
Cryptogenic
cirrhosis |
5 |
9 |
4 |
4 |
9 |
6 |
|
Budd Chiari
syndrome* |
5 |
0 |
3 |
5 |
6 |
6 |
|
Other
cholestatic diseases |
4 |
0 |
1 |
6 |
9 |
9 |
|
Other |
23 |
14 |
17 |
7 |
8 |
19 |
|
Totalt |
192 |
169 |
164 |
175 |
161 |
141 |
*Patients with
Budd Chiari syndrome may be recorded as acute hepatic failure if listed as
urgent, the figures given for Budd Chiari
in this table
exclude patients listed as acute hepatic failure
Age distribution of
patients receiving a first liver transplant in 1996-2001 (age at transplantation)
|
age - year |
2001 |
2000 |
1999 |
1998 |
1997 |
1996 |
|
<1 |
10 |
2 |
7 |
6 |
2 |
4 |
|
1-2 |
1 |
4 |
2 |
2 |
6 |
3 |
|
2-10 |
5 |
2 |
10 |
8 |
4 |
6 |
|
11-20 |
6 |
5 |
7 |
4 |
8 |
4 |
|
21-30 |
19 |
19 |
7 |
6 |
12 |
12 |
|
31-40 |
21 |
14 |
18 |
23 |
17 |
14 |
|
41-50 |
40 |
50 |
38 |
48 |
44 |
33 |
|
51-60 |
50 |
56 |
50 |
53 |
42 |
47 |
|
>60 |
40 |
26 |
23 |
23 |
24 |
18 |
Distribution of some of the major diagnoses (patients receiving a 1.liver allograft) – centerwise – 1995-2001
|
|
Copenhagen |
Gothenburg |
Helsinki |
Oslo |
Stockholm |
|
AHF |
29 |
21 |
53 |
14 |
25 |
|
ALCI |
51 |
49 |
17 |
10 |
18 |
|
AUCI |
7 |
21 |
4 |
6 |
7 |
|
BIAT |
13 |
11 |
8 |
15 |
16 |
|
BCDI |
4 |
6 |
6 |
5 |
5 |
|
CRCI/OCCI |
22 |
22 |
16 |
10 |
9 |
|
MEDI |
8 |
10 |
6 |
7 |
44 |
|
PBCI |
16 |
27 |
36 |
15 |
19 |
|
PCYS |
6 |
7 |
0 |
2 |
0 |
|
PHCC |
9 |
27 |
3 |
9 |
38 |
|
PHCB |
4 |
17 |
0 |
3 |
14 |
|
SCCH |
20 |
49 |
29 |
42 |
49 |
|
HCCA |
2 |
10 |
14 |
2 |
33 |
|
OTCA |
3 |
18 |
2 |
3 |
6 |
AHF - acute hepatic failure
ALCI - alcoholic cirrhosis
AUCI - autoimmune hepatitis-cirrhosis
BCDI - Budd Chiari (only chronic cases)
BIAT - biliary atresia
CRCI/OCCI – cryptogenic cirrhosis and cirrhosis other
causes
MEDI - metabolic diseases
PBCI - primary biliary cirrhosis
PCYS polycystic
liver disease
PHCC - HCV cirrhosis
PHCB - HBV cirrhosis
SCCH – primary
sclerosing cholangitis
HCCA - hepatocellular carcinoma
OTCA
- all other cancers including
cholangiocarcinoma, other primary hepatic cancers and secondary cancers
Activity 1982-2001
A total of 2005 first liver transplantations and 236 retransplantations have been performed since 1982,
the distribution among the centres is given below.
Survival
curves for the total material, for different time periods and for major
diagnostic groups are given.
In addition
survival curves for a limited number of diagnoses – primary sclerosing
cholangitis, primary biliary cirrhosis,
HCV and HBV
are presented. The survival curves comprise data for all patients who have
received a liver allograft as of March 1. 2002
|
|
1.liver transplants |
Retransplants |
Total number |
|
Helsinki |
363 |
43 |
406 |
|
Stockholm |
520 |
50 |
570 |
|
Gothenburg |
515 |
56 |
571 |
|
Copenhagen |
332 |
48 |
380 |
|
Oslo |
254 |
36 |
290 |
|
Aarhus |
20 |
3 |
23 |
|
total |
2004* |
236 |
2241 |
* One additional patient recorded with a first transplant in
Uppsala 2001.
Survival curves
Publications NLTR 1990-2001
1. Keiding S, Ericzon BG, Eriksson S, Flatmark A, Hockerstedt K, Isoniemi H, Karlberg I, Keiding N, Olsson R, Samela K, Schrumpf E. Survival after liver transplantation of patients with primary biliary cirrhosis in the Nordic countries. Comparison with expected survival in another series of transplantations and in an international trial of medical treatment. Scand J Gastroenterol 1990; 25:11-8
2. Hockerstedt K, Ericzon BG, Eriksson LS,
Flatmark A, Isoniemi H, Karlberg I, Keiding N, Keiding S, Olsson R, Samela K.
Survival after liver transplantation for primary biliary cirrhosis: use of
prognostic indices for comparison with medical treatment. Transpl Proc 1990;
22:1499-500
3. Hockerstedt K, Isoniemi H, Ericzon BG,
Broome U, Friman S, Persson H, Bergan A, Schrumpf E, Kirkegaard P, Hjortrup A.
Is a 3-day waiting list appropriate for patients with acute liver failure?
Transpl Proc 1994;26:1786-7
4. Bjøro K, Friman S, Höckerstedt K,
Kirkegaard P, Keiding S, Schrumpf E, Olausson M, Oksanen A, Isoniemi H,
Hjortrup A, Bergan A, Ericzon BG. Liver transplantation in the Nordic countries, 1982-1998: Changes of indications
and improving results. Scand J Gastroenterol 1999;34:714-722
5.
Bjøro K,
Höckerstedt K, Ericzon BG, Friman S,
Hjortrup A, Keiding S, Schrumpf E, Duraj F, Olausson M, Mäkisalo H, Bergan A,
Kirkegard P. Liver transplantation in patients over 60 years of age. Transpl
Int 2000; 13, 165-170
6. Bjøro K, Kirkegaard P, Ericzon BG,
Friman S, Schrumpf E, Isoniemi H, Herlenius G, Olausson M, Rasmussen A, Foss A,
Höckerstedt K. Is a 3-day limit for highly urgent liver transplantation for
fulminant hepatic failure appropriate – or is the diagnosis in some cases
incorrect? Transpl Proceed 2001;33:2511-3
7. Ericzon BG, Bjøro K, Höckerstedt K,
Hansen B, Olausson M, Isoniemi H, Kirkegaard P, Broome U, Foss A, Friman S.
Time to request AB0-identity when transplanting for fulminant hepatic failure?
Transpl Proc 2001;33:3466-7
8.
Olausson M,
Mjornstedt L, Backman L, Lindner P, Olsson R, Krantz M, Karlsen KL, Stenqvist
O, Henriksson BA, Friman S. Liver transplantation--from experiment to routine
care. Experiences from the first 500 liver transplantations in Gothenburg
Lakartidningen 2001;98:4556-62
9.
Brandsæter B ,
K Höckerstedt, BG Ericzon, S Friman, P Kirkegaard, H Isoniemi, Foss A, Olausson
M, Hansen B, Bjøro K: Outcome following listing for liver transplantation due
to fulminant hepatic failure in the Nordic countries. Submitted for publication
10. Bjøro K, Ericzon BG, Kirkegaard P,
Höckerstedt K, Söderdahl G, Olausson M, Foss A, Schmidt LE, Brandsæter B,
Friman S. Liver transplantation for fulminant hepatic failure: impact of
donor-recipient ABO-matching on the outcome. Submitted for publication
abstracts
11. Bjøro K, Keiding S, Ericzon BG, Friman
S, Olausson M, Kirkegaard P, Hjortrup A, Höckerstedt K, Isoniemi H, Bergan A,
Schrumpf E. The Nordic liver transplant registry. Organisation and outcome of
1160 patients accepted for liver transplantation 1990-1996. Scandinavian
Congres for Organ transplantation, Oslo 1997, abstract
12. Bjøro K, Keiding S, Ericzon BG, Friman
S, Olausson M, Kirkegaard P, Hjortrup A, Höckerstedt K, Isoniemi H, Bergan A,
Schrumpf E. Indication for liver transplantation in the Nordic countries during
1982-1996. Scandinavian Congress for Organ transplantation, Oslo 1997, abstract
13. Bjøro K, Olsson R, Broome U,
Höckerstedt K, Schrumpf E, Kirkegaard P, Isoniemi H, Ericzon BG, Olausson M,
Hansen B, Bergan A, Friman S. Liver transplantation for primary sclerosing
cholangitis (PSC). 9th
Congress of the European Society for Organ transplantation, Oslo 1999, abstract
no 52
14. Höckerstedt K, Ericzon BG, Bjøro K,
Friman S, Hjortrup A, Keiding S, Schrumpf E, Duraj F, Olausson M, Mäkisalo H,
Bergan A, Kirkegaard P. Liver transplantation in patients above 60 years of
age. 9th Congress of the European Society for Organ transplantation,
Oslo 1999, abstract no 1177
15. Bjøro K, Keiding S, Friman S, Ericzon
BG, Kirkegaard P, Schrumpf E, Olausson M, Broome U, Isoniemi H, Hansen B,
Bergan A, Höckerstedt K. Outcome of patients listed for liver transplantation
in the Nordic countries 1990-1998. 9th Congress of the European
Society for Organ transplantation, Oslo 1999, abstract no 1178
16. Bjøro K, Kirkegaard P, Ericzon BG,
Schrumpf E, Isoniemi H, Söderdahl G, Olausson M, Hansen B, Foss A, Höckerstedt
K. Liver transplatnation for fulminant hepatic failure in the Nordic countries
1990-1999. XVII International Congress
of the Transplantation Society, Rome 2000, abstract no 783
17. Bjøro K, Kirkegaard P, Ericzon BG,
Friman S, Schrumpf E, Isoniemi H, Herlenius G, Olausson M, Rasmussen A, Foss A,
Höckerstedt K. Is a 3-day limit for highly urgent liver transplantation for
fulminent hepatic failure appropriate -
or is the diagnosis in some cases incorrect. Scandinavian Congress for organ
transplantation, Helsinki 2000, abstract
18. Foss A, Höckerstedt K, Ericzon BG,
Friman S, Kirkegaard P, Bergan A, Mäkisalo H, Söderdahl G, Olausson M, Hansen B, Bjøro K. Improved
outcome after liver transplantation for fulminant hepatic failure during 1990
to 1999. Scandinavian Congress for organ transplantation, Helsinki 2000,
abstract
19. Brandsæter B, Höckerstedt K, Hansen B,
Ericzon BG, Bjøro K, Olausson M, Isoniemi H, Kirkegaard P, Söderdahl G, Foss A,
Friman S. Fulminant hepatic failure – outcome after listing for highly urgent
liver transplantation – impact of AB0 blood type. 36th Annual
meeting European Association for the Study of Liver Diseases, Prague 2001,
abstract no 1423
20. Bjøro K, Höckerstedt K, Friman S,
Kirkegaard BG, Ericzon BG. Outcome after listing for highly urgent liver
transplantation – impact of AB0 blood type. Joint Meeting of International
Liver Transplantation Society and European Liver Transplantation Association.
Berlin 2001, abstract no 91
21. Ericzon BG, Bjøro K, Höckerstedt K,
Hansen B, Olausson M, Isoniemi H, Kirkegaard P, Söderdaghl G, Foss A, Friman S.
Time to request AB0-identity when transplanting for fulminant hepatic failure?
Transpl odysse, Istanbul, August 2001
22. Brandsæter B. Outcome of liver
transplantation for primary sclerosing
cholangitis in the Nordic countries. Second European
Transplant Fellow Workshop. Zürich,
30.11-01.12.
23.
Brandsæter B,
Friman S, Ericzon BG, Höckerstedt K, Kirkegaard P, Olausson, Broome, Isoniemi
H, Hansen B, Schrumpf E, Bjøro KOutcome following listing for liver
transplantation in primary sclerosing cholangitis. European Assoc for the Study
of Liver Disease, Madrid, April 2002
24. Brandsæter B, …… Primary sclerosing
cholangitis in the Nordic countries – survival after liver
transplantation. The XXIV Nordic
Meeting of Gastroenterology, Aarhus May 2002
25. K Bjoro, K Höckerstedt, S Friman, BG
Ericzon, L Schmidt, B Brandsæter, H Isoniemi, M Olausson, G Söderdahl, A Foss,
P Kirkegaard. Fulminant hepatic failure – outcome following liver
transplantation. The XXIV Nordic Meeting of Gastroenterology, Aarhus May 2002.