Introduction

The characteristics of liver transplant (LT) recipients have evolved over time as centers adapt to allocation policy changes and the shifting demographics of the US population. We aim to analyze the temporal trends of LT recipient demographic and medical characteristics.

Methods

This study analyzed demographic and medical characteristics for all LT recipients of LT from 2002-2015 using a UNOS STAR file. Continuous variables were analyzed by Student's t-test while categorical variables were analyzed by chi-squared test.

Results

From 2002 to 2015, 79,762 patients underwent LT with a trend towards increase in annual LT volume (4,733 to 6,450). Median age at LT from 52 to 58 (p<0.001). While the proportion of white recipients decreased, African American, Hispanic, and Asian recipients significantly increased (p<0.001). Privately insured patients significantly decreased from 84.1% to 56.7% (p<0.001), while publicly insured recipients more than tripled (12.8% to 42.7%, p<0.001). Additionally, LT recipients were increasingly likely to attain greater than a high school education (31.4% to 49.2%, p<0.001). LT recipients were more commonly diabetic with higher median BMI and less independently functional, as assessed by Karnofsky scores ≥ 60, at listing (74.8% to 63.7% p<0.001) and LT (65.2% to 45.8% p<0.001). The final calculated MELD has significantly increased from 17 to 20, p<0.001. Patients more likely underwent LT while hospitalized (15.1% to 20.2%) and in the intensive care unit (12.9% to 16.3%), both p<0.001. Hepatitis C (33.4% to 17.3%) and hepatitis B (6.3% to 1.8%) decreased as indications for LT, while NASH (7.2% to 14.2%) and hepatocellular carcinoma (7.4% to 25.7%) increased, all p<0.001. Over the study interval, both 1 and 3-year post LT survival has improved from 81.6% to 86.9% and 70.7% to 75.7%, respectively, both p<0.001.

Conclusion

Transplantation of a more racially diverse and publicly insured group of patients suggests more equitable access to LT across socioeconomic groups in the US. Despite LT recipients being older and sicker compared to 2002, post-LT survival has significantly improved. The impact of transplanting sicker, diabetic, obese, but less functional patients will need to be carefully examined beyond the 1 and 3-year outcomes scrutinized by the SRTR to truly assess our current listing practices.

CITATION INFORMATION: Rosenblatt R., Shen N., Tafesh Z., Fortune B., Halazun K., Jesudian A. Evolving Trends in Demographic and Medical Characteristics of Liver Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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