AUSTRALIA & NEW ZEALAND - Sydney Local Health District 24th... · The Australia and New Zealand...

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Fr om the C om bine d R e g is t r i e s

o f the A us t r a l i a n a nd N e w Ze a la nd

L iv e r Tr a ns p la n t C e n t r e s

D A T A T O 3 1 - 1 2 - 2 0 1 2

Brisbane

Sydney

Melbourne

dn

ala

eZ

w

eN

Perth

Auckland

24TH

R E P O R T

Adelaide

AUSTRALIA & NEW ZEALANDAUSTRALIA & NEW ZEALAND

© copyright ANZLTR Data to 31.12.2012

© copyright ANZLTR Data to 31.12.2012

COORDINATING CENTRE

ANZLT Registry www.anzltr.orgPrincess Alexandra HospitalIpswich RdWOOLLOONGABBA, QLD, 4102

Professor Stephen Lynch EditorMs Glenda Balderson Editor/Liaison OfficerMs Debra Cormack Graphics

Phone (61-7) 3176 2385 G.Balderson Fax (61-7) 3176 2999 G.Balderson

Email [email protected]

MANAGEMENT COMMITTEE

Professor L. DelreviereSir Charles Gairdner Hospital, WA

Professor R.M. JonesAustin Hospital, VIC

Professor S.V.LynchPrincess Alexandra Hospital, QLD

Professor G.W. McCaughanRoyal Prince Alfred Hospital, NSW

Professor S. MunnAuckland Hospital, NEW ZEALAND

Dr. R. PadburyFlinders Medical Centre, SA

MS G.A. BaldersonPrincess Alexandra Hospital, QLD

FUNDING

ANZLTR receives majority funding from the Australian Organ and Tissue Authority supplemented by funds from Janssen-Cilag Pty Ltd.

CITATION

The suggested citation for this report is as follows : ANZLT Registry Report 2012 Australia and New Zealand Liver Transplant Registry Brisbane, QLD, AUSTRALIA Editors: S.V. Lynch, G.A. Balderson

STATISTICAL METHODS

Kaplan-Meier survival curves have been produced using IBM SPSS® for Windows™ Release 21.0.

ACKNOWLEDGMENT

The Cancer Registry is maintained at Transplantation Services, Royal Prince Alfred Hospital, Sydney. Report prepared by Pamela Dilworth, Marie Mulhearn and Dr Deborah Verran.

Director: Professor G.W McCaughanAll queries to: Dr Deborah Verran Email [email protected]

ContentsContentsPreface

Summary

Section 1

Summary Statistics

Number of New Patients

Age of Recipients

Number of Transplants and Type of Graft by Year

Section 2

Primary Diseases of Recipients

Primary Diagnosis by Era

Chronic Viral Hepatitis - Adults Recipients

Section 3

Patient Survival

Patient Survival by Age at Primary Transplant and Era of Transplant

Patient Survival by Type of Primary Graft

Patient Survival by Weight at Transplant - Children

Patient Survival by Primary Disease

Section 4

Graft Survival

Indication for Retransplantation

Section 5

Causes of Patient Death

Section 6

Deceased Donors by Year

Donor Age and graft outcome

Section 7

Living Donor Transplantation

Section 8

Waiting List Activity and Outcome

Waiting Time by Blood Group and Outcome

Section 9

Summary and Type of Primary Liver Cancer

Primary Liver Malignancy - Survival, Incidence and Mortality

Liver Cancer as Secondary Diagnosis - Type and Outcome

De Novo Non Skin Cancers

Skin Cancers Post Transplant

Cumulative Rate of Cancer Development

Appendix I - Transplant Units Australia and New Zealand

Appendix II - Metabolic Disorders

Appendix III - Other Diseases

Appendix IV - Fulminant Hepatic Failure

Appendix V - Causes of Patient Death

1

2-4

Demographic Data

5

6

7

8-9

Primary Diagnosis

10-11

12-13

14-15

Patient Survival

16

17-19

20

21

22-24

Graft Outcome

25-27

28-29

Causes of Death

30-33

Deceased Donor Information

34

35

Living Donor Transplantation

36

Waiting List

37-38

39

Liver Transplantation and Cancer

40

41-43

43-46

47-50

51

51

52

53

54

55

56

CONTENTS

24TH

ANZLT REGISTRY

R E P O R T

DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012

PrefacePreface

1.

PREFACE

We are pleased to present the 24th Report of the Australia and New Zealand Liver

Transplant Registry (ANZLTR). This report contains data to the 31st December 2012

and analyses the cumulative data since the establishment of the first liver

transplantation unit in Australia or New Zealand in 1985.

The Australia and New Zealand Liver Transplant Registry (ANZLTR) is a

collaborative effort of the liver transplantation centres in Australia (Adelaide,

Brisbane, Melbourne, Perth, Sydney) and New Zealand (Auckland). The Registry is

supervised by the Management Committee which is involved in the ongoing

supervision of the development of the Registry. The members of the Management

Committee are listed on the front page.

Donor data have been supplied by the Australia and New Zealand Organ Donor

Registry and we thank them for their collaboration.

The Editors would also like to thank the staff of all the Liver Transplant Units who

contribute their data by direct entry into the ANZLTR database. A full list of the Units

and their contact information can be found in Appendix I. In particular we are grateful

to the efforts of Pamela Dilworth, Program Manager and Marie Mulhearn for their

continuing contribution to the maintenance of the Cancer Registry which is based at

the Royal Prince Alfred Hospital, Sydney and who, together with Dr Deborah Verran,

prepare the Cancer Report.

The registry has financial support and we are grateful to the Australian Government,

through the Australian Organ and Tissue Authority, for their financial contribution.

Some additional funds are received from Janssen-Cilag Pty Ltd on an ad hoc basis.

Comments are always welcome and should be forwarded to the Coordinating

Centre at the contact information listed on the front page as should requests for

further copies of this Report. The report is now also available on the ANZLTR public

web site www.anzltr.org from where the report can be downloaded. Slides are

available on request from the Coordinating Centre.

Stephen Lynch

Glenda Balderson

24TH

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SummarySummary

2.

SUMMARY

5. Between January 1985 and 31st December 2012, 4302 orthotopic liver transplants (OLT) were performed in Australia and New Zealand on 3980 patients, 3266 adult patients [82%] and 714 children ( < 16 years) [18%]. The median age of all recipients was 47.6 years. The ages ranged from 24 days to 73.1 years. There is a significant difference in gender distribution between children (M=47%) and adults (M=65%)

6. Two hundred and forty-six new patients were transplanted in 2012 compared with 225 in 2011.

7. The trend to increasing age of adult recipients in recent years continued and the overall adult median age is now 50.4 years. The median age of new adult recipients in 2010-12 was 54.0 years.

8-9. In 2015,15 more transplants were performed than in 2011 [268 vs 253]. Split grafts continue to make a significant contribution to the total number of paediatric transplants performed providing 21 of 46 [46%] grafts in 2012 and 197 of 812 [24%] overall. In children, other reduced size grafts have been used in 367 [45%] cases including 63 living donor grafts. One child has been treated with liver cell implantation. Of adult patients, 245 have received reduced size grafts - 203 split liver grafts (including 1 as auxiliary graft), 29 other reduced size grafts (1 as auxiliary graft) and 13 living donor grafts. One domino transplant of a whole liver has been performed.

10-11. Overall, chronic viral hepatitis (CVH) is the most common primary indication for liver transplantation. In children biliary atresia (BA) is the most common primary disease. In adults chronic hepatitis C [CVH : HCV] is the primary disease in 22.4% of recipients and chronic hepatitis B [CVH : HBV] in 6.2 %. Full details of specific diagnoses categories by age group are listed in the Appendices for - Metabolic disorders (Appendix II), Other diseases (Appendix III), Fulminant Hepatic Failure (Appendix IV).

12-15. The number of patients transplanted for non alcoholic fatty liver disease [ NAFLD/NASH] continued to increase with 12 new patients transplanted in 2011 bringing the total to 81. While the proportion of adult patients transplanted with a primary diagnosis of chronic viral Hepatitis B, C or B/C/D has fallen slightly in era 2010-12 compared with the previous eras, the number with a primary diagnosis of hepatocellular carcinoma [HCC] is higher at 13% with the majority of these patients having a secondary diagnosis of CVH. When patients with either primary or secondary diagnosis of Hepatitis B,C or both are included, the overall incidence of CVH in new adult patients in 2012 was 45%.

16. Overall 1 year patient survival of all patients is 89% at 1 year, 81% at 5 years and 72% at 10 years. Children have a significantly better survival rate than adults with an actuarial survival of 71% at 25 years post-transplant.

17. Whilst older children had superior early survival than infants and babies, long term survival is similar. Older adult recipients (60-65 and >65 years) had poorer longer term outcomes.

18-19. Patient survival in 2000-04 cohort shows continued improvement in outcome for the first 10

years compared with earlier cohorts. This is seen in both children and adults. One year patient survival in 2010-12 cohort was 92% for all patients [94% for children, 92% for adults].

20. In both children and adults, there are worse early outcomes in patients receiving a deceased donor reduced size graft as their primary graft compared with split liver graft or whole liver grafts. Split liver grafts and whole livers have similar early outcomes in both children and adults.

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3.

SummarySummary

SUMMARY

21. Smaller children and babies weighing < 8 kg at the time of transplant had inferior early survival compared to heavier children but similar long term results.

22. Adult patients transplanted for biliary atresia or hepatitis virus co-infections had the best longer term survival while those whose primary disease was malignancy or Hepatitis C have significantly lower survival rates.

23. In children, patient survival was similar for all disease groups though lower in patients whose primary disease was malignancy. There were no differences in survival between adults and children transplanted for fulminant hepatic failure [acute and sub-acute] with overall 5 year survival of 77%.

24. Recent cohorts of adult patients with a primary diagnosis of hepatitis B continue to show a significantly improved survival which is not seen in adult patients with hepatitis C as primary disease. Patients transplanted for malignancy continue to have a poor outcome but some improvement in longer term outcome is seen in patients transplanted since 2000.

25-26. Overall graft survival was 76% at 5 years with significantly better graft survival longer term in children . Survival was significantly worse in second and third grafts in both children and adults.

27. Overall split liver grafts have similar graft survival to whole liver grafts. Reduced grafts have lower graft survival in the early post-transplant years in both children and adults.

28-29. Vascular complications and rejection were the commonest indications for re-transplantation. Twelve percent of retransplants were due to poor early graft function. Re-transplantation for recurrent disease was most prevalent in adults [9% PSC, PBC, AIH and 9% HBV, HCV].

30-33. Sepsis is the most frequent cause of death in both adults and children. Full details of Miscellaneous and Other Graft Failure deaths are listed in Appendix V. Thirty-two percent of all deaths occurred within 6 months of transplant. Early graft failure was due to poor or no early graft function. By 1 year malignancy and graft failure from recurrent disease or chronic rejection cause most deaths. Deaths due to de novo malignancy and chronic rejection are increasing with longer survival time.

34. There was an increase in the number of cadaveric donors in 2012 with 261 grafts transplanted from deceased donors. The number of livers split to produce two transplantable grafts was 21 in 2012. Seventeen liver grafts donated after cardiac death were transplanted. The number of people on the waiting list at 31 December 2012 was similar to the number on the waiting list at 31 December 2011.

35. Donor age has increased significantly in recent years. Long term graft survival trends lower in several older donor age groups.

36. Seventy-seven patients [63 children, 14 adults] have now received a living donor graft with 7 performed in 2012. Seventy-one were transplanted as a primary graft, 5 as a second and 1 as a third graft. The median age of the donors was 33.8 years with a range of 20.1 to 54.5 years. One adult graft was a domino whole liver graft.

37. This data has been expanded to include a breakdown of total waiting list activity for 2012 by age group. The number of patients listed for transplantation continued to increase in 2012 with 182 remaining on the waiting list at 31 December 2012. Patient delistings due to death, becoming too ill or tumour [HCC] progression accounted for 10% of all delistings while 268 [50%] were transplanted. Thirty five patients were listed as urgent in 2012[16 with initial listing as Category 1 and 19 Category 2]. Thirteen [81%] of Category 1 and 17 [89%] of Category 2 patients had a positive outcome.

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4.

SummarySummary

SUMMARY

38-39. Median waiting times tended to be higher in 2012 in some blood groups. Blood group O patients had the longest waiting times.

40. Cancer in liver transplant recipients was analysed from two perspectives. Firstly, those who had a liver cancer diagnosis at the time of transplantation (as primary, secondary or incidental) and secondly those who developed a cancer post transplantation (de novo skin and de novo non skin cancer). Overall 766 (18%) patients were transplanted who had a liver malignancy - 295 (7%) as a primary diagnosis and 471 (12%) as a secondary diagnosis or incidental tumour, with Hepatocellular carcinoma being the most common. Post transplant 113 (16%) of these patients developed a recurrent cancer whilst 97 patients' death was related to this initial type of tumour.

41-43. The longer term survival of patients with liver cancer is significantly poorer for the subgroup of patients with Hepatoblastoma. There also continues to be an increase in the number of patients being transplanted for primary malignancy in the patient cohort for the time period of 2009-2012 with Hepatocullular Carcinoma being the most common underlying cause.

43-45. Four hundred and seventy one [12%] had liver cancer as a secondary or incidental diagnosis with hepatocellular carcinoma the most common. Of these 48 (10%) died from their malignancy. Those with cholangiocarcinoma had significantly poorer survival.

46. Patient survival was significantly worse in the 768 (19%) patients with pre transplant liver malignancy compared with patients with other forms of liver disease.

47-48. Three hundred and nine de novo non-skin cancers developed in 295 patients (7%). Eleven patients developed more than one type of de novo cancer. One hundred and twenty-two (41%) patients died from their de novo cancer. Cancers of the alimentary tract (114) and lymphoma (79) are the two most common types of de novo cancer.

49-50. For the alimentary tract cancers the colon was the predominate site (59). The incidence of de novo non-skin cancers appears to vary according to the diagnosed pre-transplant liver disease, with the incidence of de-novo non-skin malignancy in patients with Primary Sclerosing Cholangitis being statistically significantly higher than for the other underlying liver diseases (p<0.0001).

51. Nine hundred and forty eight patients (25%) developed 3809 skin cancers with 555 patients having multiple skin cancer types and 29 developed melanoma.

Of note, the cumulative risk of diagnosis of any cancer post transplant is approaching 40% by 20 years.

24TH

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R E P O R T

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Section 1D e m o g r a p h i c D a t a

Section 1

SECTION 1 : DEMOGRAPHIC DATA

24TH

ANZLT REGISTRY

R E P O R T


Year of Transplant

Summary Statistics - Age and Gender

ALL PATIENTS TRANSPLANTED

Cumulative Number of Patients & Transplants

Children [<16y] Adults Total

Patients 714 3266 3980

Age

Mean ± SD 4.5 ± 4.5y 48.5 ± 11.6y 40.6 ± 20.0y

Median 2.4y 50.4y 47.6y

Range 24d -15.9y 16.0 - 73.1y 24d - 73.1y

Gender

Female 381 (53%) 1146 (35%) 1527 (38%)

Male 333 (47%) 2120 (65%) 2453 (62%)

Surviving 573 (80%) 2314 (71%) 2887 (73%)

5.


Num

ber

Transplants

(n=4302)

Patients

(n=3980)

2,000

1,500

1,000

500

0

1985

2,500

3,000

3,500

4,000

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

4,500

24TH

ANZLT REGISTRY

R E P O R T


Number of New Patients Transplanted by Year

Year of Transplant6.


Cumulative Number of New Patients Transplanted

Num

ber

of P

atie

nts

Num

ber

of P

atie

nts

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

120

100

80

20

140

160

180

200

40

60

220

240

1,200

1,000

800

200

0

400

600

1,600

1,400

2,000

1,800

2,400

2,200

2,600

3,000

2,800

2010

2011

3,200

0

Age Group

Adult (n=3266)

Children (n=714)

2012

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

3,400

Age Group

Adult (n=3266)

Children (n=714)

24TH

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R E P O R T

44

202


7.


Number of Recipients By Age at Primary TransplantN=3980

Age Strata

Age at Primary Transplant by Era

Count

600

500

400

300

200

100

0

700

800

900

1,000

1,100

< 1y 1 - 2y 3 - 9y 40 - 49y16 - 39y10 - 15y 50 - 59y 60 - 64y >=65y

Median = 47.6yRange 24d - 73.1y

1,200

1,300

24TH

ANZLT REGISTRY

R E P O R T

163

348

240 199

111

640

937

1,231

110

Ag

e a

t tr

an

spla

nt

Era

2.5y 2.9y 2.5y 2.5y 2.2y

P=ns

43.9y45.9y

48.1y50.2y

52.2y

P<0.001

Adult (n=3266) Median = 50.4y [16.0 - 73.1y]

Children (n=713) Median = 2.4y [24d - 15.9y]

Age Group

54.0y

1.8y

40

30

20

10

0

50

60

70

80

1985 - 89 1990 - 94 1995 - 99 2000 - 04 2005 - 09 2010 - 12


8.


Number of Transplants by Year

Cumulative Number of Transplants

Num

ber

of T

ransp

lants

Num

ber

of T

ransp

lants

Year of Transplant

1,250

1,000

750

250

500

1,750

1,500

2,250

2,000

2,750

2,500

3,000

3,500

3,250

125

100

25

150

175

200

50

75

225

250

275

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Adult (n=3490)

Children (n=812)

Age Group

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

Age Group

Adult (n=3490)

Children (n=812)

24TH

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46

222


9.


Type of Graft by YearSplit vs Reduced vs Whole

Adults (n = 3490)

Children (n = 812)N

um

ber

of G

rafts

Num

ber

of G

rafts

Year of Transplant

25

20

5

0

30

35

40

10

15

45

50

100

80

60

0

40

140

120

180

160

200

220

20

Liver cells

Split

Reduced

Whole

Type of Graft

Split - LRD

n= 1

n= 197 (24%)

n= 304 (37%)

n= 247 (31%)

n= 63 (8%)

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Split

Reduced

Whole

Type of Graft

Split - LRD

* 1 domino liver

n= 203 (6%)

n= 29 (0.6 %)

n= 3245 (93%)*

n= 13 (0.4%)

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8


Section 2P r i m a r y D i a g n o s i s

Section 2

SECTION 2 : PRIMARY DIAGNOSIS

24TH

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R E P O R T


BA

MET

ALD

CC

PBC

PSC

MAL

FHF

OTH

CAH : AI

CVH : HBV

CVH : HCV

CVH : B/C/D

Primary Diseases of All Recipients


10.

Diagnosis Group

- Biliary atresia

- Metabolic diseases

- Alcoholic cirrhosis

- Cryptogenic cirrhosis

- Primary biliary cirrhosis

- Primary sclerosing cholangitis

- Malignancy

- Fulminant hepatic failure

- Other diseases

- Chronic active hepatitis [autoimmune]

- Chronic viral hepatitis B

- Chronic viral hepatitis C

- Chronic viral hepatitis B / C / D

BA10.9%

MET6.5%

ALD10.3%

CC4.6%

PBC5.2%

CVH : HCV18.4%

CVH : HBV5.1%

OTH8.5%

FHF9.7%

MAL7.5%

PSC8.8%

*

**

See Appendices for details *

CAH : AI3.5%

CVH : B/C/D1.1%

24TH

ANZLT REGISTRY

R E P O R T


Primary Diseases of Adult Recipientsn = 3266


11.

Primary Diseases of Childrenn =714

OTH11.9%

FHF10.5%

MAL

PSC

MET14.4%

CAH:AI

BA56.0%

BA

MET4.8%

ALD12.5%

CC5.1%

PBC6.3%

1%

CVH : HCV22.4%

CAH:AI4.1%

OTH7.7%

FHF9.5%

MAL8.5%

PSC10.6%

CC2.2%

1.0%

2.9%

1.0%

CVH : HBV6.2%

CVH : B/C/D1.4%

MAL

FHF

OTH

CAH : AI

CVH : HBV

CVH : HCV

CVH : B/C/D

- Malignancy

- Fulminant hepatic failure

- Other diseases

- Chronic active hepatitis [autoimmune]

- Chronic viral hepatitis B

- Chronic viral hepatitis C

- Chronic viral hepatitis B / C / D

BA

MET

ALD

CC

PBC

PSC

- Biliary atresia

- Metabolic diseases

- Alcoholic cirrhosis

- Cryptogenic cirrhosis

- Primary biliary cirrhosis

- Primary sclerosing cholangitis

Diagnosis Group

24TH

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R E P O R T


Primary Diseases


12.Primary Diagnosis Group

Perc

ent of N

ew

Patie

nts

Perc

ent of

New

Patie

nts

Adults (n = 3266)

Children (n=713)

BiliaryAtresia

Metabolic diseases

Cryptogeniccirrhosis

PSC Malignancy FHF Other diseases

CAH : AI

CAH:AI

OTHFHFPSCPBCCCMETBA ALD CVH:Mixed

CAH:HBV

CAH:HCV

30%

10%

0%

40%

50%

60%

20%

70%

10%

5%

0%

15%

20%

25%

30%

2005-09 (n=152)

2000-04 (n=112)

1995-99 (n=117)

1990-94 (n=141)

1985-89 (n=75)

Era

2010-12 (n=116)

MAL

2005-09 (n=810)

2000-04 (n=748)

1995-99 (n=580)

1990-94 (n=411)

1985-89 (n=130)

Era

2010-12 (n=587)

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Adult Primary Diagnosis by Era


13.

Adult Diagnosis

Hep B/C/D

ALD

Other diseases

Hep C

HCC

Hep B

1985 - 89 (n=130)

1990 -94 (n-411)

1995 - 99 (n=580)

2000 - 04(n=748)

2005 - 09(n=810)

2010 - 12(n=587)

7%

3%

8%

8%

1%

12%

5%

5%

13%

3%

6%

NAFLD/NASH

Era

6%

2%

2%

2%

1%

1%

15%

13%

10%

74%

55%

42% 25%

28%37%

12%

35% 29%

14%

19%

9%

8%

3%

8%

5%75%

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Adult Primary Diagnosis by Year


14.

Year of Transplant

Count

80

40

0

120

200

160

180

140

100

60

20

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Hep B/C/D

Hep B

Hep C

HCC

ALD

NAFLD/NASH

Primary Diagnosis

Other diseases

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65



15.

Hepatitis C 731 7 186 3 188

Hepatitis B 203 3 73 5

Hepatitis 43 5 7

BD/BC/BCD

HCC + cirrhosis 260 120 68 6 5 42

ALD 408 18 3 49 6

NAFLD 81 2 13 3

Other 1539 15 8 49 3 22

Pri

mar

y D

iagn

osis

Type of Chronic Viral Hepatitis in Adult Patients

Chronic Viral Hepatitis as Primary or Secondary Diagnosis in Adult Patients

1990-94[n=71]

1995-99[n=190]

2000-04[n=321]

2005-09[n=363]

Era

37%

59%

4%

33%

65%

2%

26%

68%

6%

19%

74%

6%

Year of Transplant

Hepatitis diagnosis

Count

2000 2001 2002 2003 2004 2005 2006 2007 2008

150

100

50

0

2009

n = Hepatitis C Hepatitis BHepatitis

B,C HCC NAFLD ALD

TOTAL 3266

Secondary / Tertiary diagnosis

11%

86%

3%

2010 - 12[n=253]

2010

200

2011

Hepatitis Negative

Mixed B/C/D

Hepatitis C

Hepatitis B

Chronic viral hepatitis

2012

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111


Section 3P a t i e n t S u r v i v a l

Section 3

SECTION 3 : PATIENT SURVIVAL

24TH

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R E P O R T


16.

Patie

nt S

urv

ival (

%)

Patie

nt S

urv

ival (

%)

Time Post-transplant (years)


Patient Survival Post Transplant

100

90

80

70

60

50

40

30

20

10

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25

0

27

89%

89%

86%

84%

84%

80%

80%

71%

78%74%

61%

48%

Adult (n=3266)

Children (n=714)

Age group

P<0.001

100

90

80

70

60

50

40

30

20

0

71%

26

1y 3y 5y 10y 15y 25y

No at risk 3303 2737 2264 1349 681 13

Actuarial Survival (%)

89% 84% 81% 72% 65% 48%

N = 3980

20y

242

55%

10

39%

28

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

24TH

ANZLT REGISTRY

R E P O R T


Patient Survival by Age at Primary Transplant

17.


Patie

nt S

urv

ival (

%)


Children n= 713

Adults n = 3266

Patie

nt S

urv

ival (

%)

100

90

80

70

60

50

40

30

20

10

0

p =ns

Age Strata

<1y (n=163)

1 - 2y (n=240)

3 -9y (n=199)

1y 5y 10y 15y

85% 82% 80% 78%

87% 80% 76% 73%

91% 87% 83% 83%

20y

76%

70%

81%

10 - 15y (n=111) 93% 90% 86% 83% 73%

3y

84%

82%

89%

93%

100

90

80

70

60

50

40

30

20

10

0

p = 0.000

Age Strata

16-39y (n=640)

40-49y (n=937)

50-59y (n=1231)

60-64y (n=348)

>=65y (n=110)

1y 5y 10y 15y

89% 84% 76% 69%

90% 81% 71% 63%

89% 81% 70% 57%

87% 75% 64%

84% 67% 50%

54%

20y

57%

51%

35%

38%

33%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

24TH

ANZLT REGISTRY

R E P O R T


All Patient Survival by Year of Transplant

18.



Patie

nt S

urv

ival (

%)

100

90

80

70

60

50

40

30

20

10

0

p < 0.00191%

70%

86%

84%

93%

60%

79%

77%

83%

85%

52%

71%

67%

60%

47%

40%

76%

64%

Era

1985-89 (n=205)

1990-94 (n=552)

1995-99 (n=697)

2000-04 (n=860)

2005-09 (n=962)2010-12 (n=703)

92%

51%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

24TH

ANZLT REGISTRY

R E P O R T


Patient Survival - Adults

19.

Patient Survival - Children



Children n = 713

Patie

nt S

urv

ival (

%)

Patie

nt S

urv

ival (

%)

Adults n = 3266

100

90

80

70

60

50

40

30

20

10

0

93%

88%

83%

77%

69%

61%

56% 56%

86%

p < 0.001

51%

78%

77%

86%

92%

1985-89 (n=75)1990-94 (n=141)1995-99 (n=117)2000-04 (n=112)

Era

2005-09 (n=152)

84%

81%

94%

2010-12 (n=116)

94%

84%

75%

Era

1985-89 (n=130)1990-94 (n=411)1995-99 (n=580)2000-04 (n=748)2005-09 (n=810)

91%

83%

70%

87% 83%

75%

59%

78%

64%

49%

69%

55%

42%

92%

29%

84%

75%

61%

43%

p < 0.001

100

90

80

70

60

50

40

30

20

10

0

2010-12 (n=587)

92%

48%

35%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

24TH

ANZLT REGISTRY

R E P O R T


20.

Patient Survival by Type of Primary Graft[Deceased donors]

Adults - n = 3253

Children - n = 655


Patie

nt S

urv

ival (

%)

Patie

nt S

urv

ival (

%)


100

90

80

70

60

50

40

30

20

10

p = 0.02

Type of Graft

Reduced (n=265)

Split (n=173)

Whole (n= 216)

92%

92%

83%

88%

87%

78%

82%83%

75%

76%

72%

83%

70%

77%

100

90

80

70

60

50

40

30

20

10

0

Type of Graft

Reduced (n=27)

Split (n=196)

Whole (3030)

P = NS89%

86%

66%

80%

82%

66%

61%

73%

52%

47%

52%

71%

70% 66%

76%

39%

0

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

62%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726

24TH

ANZLT REGISTRY

R E P O R T


21.

Patient Survival by Weight - Children


Patie

nt S

urv

ival (

%)


100

90

80

70

60

50

40

30

20

10

0

Weight Group

5-8 kg (n=155)

> 8 kg (n=551)

< 5 kg (n=8)

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

P = NS91%

81%

75%

86%

77%

75%

80%

82%

74%

75%

74%

75%

74%

75% 74%

71%

24TH

ANZLT REGISTRY

R E P O R T


Time Post-transplant (years)22.


(1) Adults [excluding FHF] - n=1151


(2) Adults [excluding FHF] - n = 1804

P

atie

nt S

urv

ival (

%)

Patie

nt S

urv

ival (

%)

100

90

80

70

60

50

40

30

20

10

0

Biliary atresia

n = 5y 10y 15y

34 84% 84% 84%

Diagnosis Group

CAH: AI 133 81% 71%

Metabolic diseases 156 82% 74% 62%

Alcholic cirrhosis 408 84% 73%

Cryptogenic cirrhosis 166 80% 68% 59%

Other 254 83% 70% 67%

59%

62%

20y

46%

46%

56%

49%

34%

p = NS

37%

CVH : B,C,D

n = 5y

9 100%

Diagnosis Group

CVH : Hep B 203 80%

CVH : Hep C 731 78%

Malignancy 277 72%

PBC 205 85%

PSC 345 81%

CVH : B,C 16 94%

CVH : B,D 18 89%

10y 15y

100% 100%

76%

65% 52%

62%

74% 64%

73% 64%

67%

58%

94%

20y

55%

48%

94%

89%

67%

p = 0.001

100

90

80

70

60

50

40

30

20

10

0

100%

35%

84%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 26

24TH

ANZLT REGISTRY

R E P O R T



(3) Paediatric recipients [excluding FHF] - n= 638

(4) Fulminant hepatic failure n = 386

Patie

nt S

urv

ival (

%)

Patie

nt S

urv

ival (

%)

23.



Patie

nt S

urv

ival (

%)

100

90

80

70

60

50

40

30

20

10

0

p = NS

Age group

Adult (n=311)Child (n=75)All Patients (n=386)

p = NS81%

67%63%

72%

78%

77%

74%77%

72%

72%

72%53%

80%

60%

55%

100

90

80

70

60

50

40

30

20

10

0

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

Biliary atresia

n = 5y 10y 15y

400 85% 81% 80%

Diagnosis Group

Autoimmune hepatitis 7

Cryptogenic cirrhosis 16 92% 83% 82%

Malignancy 21 64% 48%

Metabolic diseases 103 88% 83% 83%

Other 84 87% 85% 82%

20y

76%

80%

82%

24%

66%

PSC 7 86%

24%

86%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 26

24TH

ANZLT REGISTRY

R E P O R T


Adults CVH: Hepatitis C n = 731

Adults CVH: Hepatitis B n = 203

Malignancy Adults and Childrenn=298

Adults (n = 277)Children (n=21)

Time Post-transplant (years)24.



Patie

nt S

urv

ival (

%)

Patie

nt S

urv

ival (

%)

Patie

nt S

urv

ival (

%)

Era

1985-89

1990-94

1995-99

2000-04

n = 5y 10y 15y

4 75% 50% 50%

34 82% 59%

109 72%

188

38%

56%

82%

2005-09 226

47%

P = NS

2010-12 170

71%

100

90

80

70

60

50

40

30

20

10

0

100

90

80

70

60

50

40

30

20

10

0

p < 0.001

1985-89 (n=12)

1990-94 (n=13)

1995-99 (n=20)

2000-04 (n=61)

Era

2010-12 (n=82)

2005-09 (n=110)

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23

100

90

80

70

60

50

40

30

20

10

0

p <0.001

1985-89 (n=9)1990-94 (n= 26)

1995-99 (n= 55)2000-04 (n= 58)

Era

2010-12 (n= 17)

84%

80%

62%78%62%

54%

22%

11% 11%

79%

2005-09 (n= 38)

92%

79%

67%

100%

24

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 26

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23

24TH

ANZLT REGISTRY

R E P O R T


Section 4G r a f t O u t c o m e

Section 4

SECTION 4 : GRAFT OUTCOME

24TH

ANZLT REGISTRY

R E P O R T


25.

Graft Survival - All Grafts


Gra

ft S

urv

ival (

%)

Gra

ft S

urv

ival (

%)

1y 3y 5y 10y 15y 25y

No at risk 3400 2770 2276 1326 667 12

Actuarial Survival (%)

85% 79% 76% 67% 60% 41%

N = 4302

100

90

80

70

60

50

40

30

20

10

0


100

90

80

70

60

50

40

30

20

10

0

Graft Survival by Age Group

81%

85%

76%

74%

69%

66%

67%

58%

61%

52%

36%

Adult (n=3490)

Children (n=812)

Age group

P= 0.018

45%

20y

230

50%


10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

24TH

ANZLT REGISTRY

R E P O R T


26.

Graft Survival by Graft Number



Gra

ft S

urv

ival (

%)

Gra

ft S

urv

ival (

%)

Gra

ft S

urv

ival (

%)

100

90

80

70

60

50

40

30

20

10

86%

71%

73%

77%

63%

62%

68%

50%

52%

61%

50%

46%

51%

33%

41%

p <0.001

Graft Number

1st Grafts (n=3979) [92.5%]

2nd Grafts (n=299) [7.0%]

3rd Grafts (n=24) [0.5%]

All Grafts (n= 4302)

84%

64%

66%

77%

57%

55%

72%

43%

46%

71%

65%

p <0.001

Graft Number

1st Grafts (n=713) [88%]

2nd Grafts (n=85) [10.5%]

3rd Grafts (n=14) [1.5%]

Children (n= 812)

100

90

80

70

60

50

40

30

20

10

0

86%

80%

77%

77%

65%

70%

67%

70%

55%

58%

70%

p =0.001

Graft Number

1st Grafts (n=3266) [94%]

2nd Grafts (n=214) [6%]

3rd Grafts (n=10) [0.3%]

100

90

80

70

60

50

40

30

20

10

49%

46%

Adult(n= 3490)

35%

36%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

55%

41%

29%

0

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

0

24TH

ANZLT REGISTRY

R E P O R T


27.

Graft Survival by Type of Graft [Deceased Donors]



100

90

80

70

60

50

40

30

20

10

0

All Grafts (n= 4224)

Children (n= 748)

Adult(n= 3476)

Gra

ft S

urv

ival (

%)

Gra

ft S

urv

ival (

%)

Gra

ft S

urv

ival (

%)

P = NS

Type of Graft

Split (n=400)

Reduced (n=333)

Whole (n=3491)

82%

73%

86%

77%

65%

77%

66%

59%

68%59%

57%

60%

38%

59%

48%

47%

< 0.001

Type of Graft

Split (n=197)

Reduced (n=304)

Whole (n=247)

84%

74%

87%

77%

66%

81%

67%

60%

77%

58%

59%

76%

56%

68%

54%

P = NS

Type of Graft

Split (n=203)

Reduced (n=29)

Whole (n=3244)

80%

62%

86%

77%

58%

76%65%

45%

66%

45%

58%

58%

45%

58%

53%

48%

36%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

100

90

80

70

60

50

40

30

20

10

010 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

100

90

80

70

60

50

40

30

20

10

0

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28

24TH

ANZLT REGISTRY

R E P O R T


28.


Biliary

PNF/poor graft function

Vascular

Rejection

Recurrent HBV /HCV

Recurrent PBC/PSC/CAH:AI

Other

Indication for Retransplantation n = 322 (298 2nd grafts, 24 3rd grafts)

Age Group

Children(n= 111)

Adults(n= 211)

20%

6%7%11%

11%

12%

6%

16%

2%

31%

8%

37%

13%

8%

9%

9%

15%14%

33%

24TH

ANZLT REGISTRY

R E P O R T

34%


29.


Num

ber

of G

rafts

43 (13%) 52 (16%) 54 (17%) 33 (10%) 67 (21%) 44 (14%)N = 29 (9%)

Biliary

PNF/poor graft function

Vascular

Rejection

Recurrent HBV /HCV

Recurrent PBC/PSC/CAH:AI Other

0

0-7d 8d- 1m 1m- 6m 6m -1y 1y- 5y 5y-10y >10y

5

10

15

20

25

30

35

40

45

50

55

60

Indication for Retransplantation n = 322 (298 2nd grafts, 24 3rd grafts)

28(13%)

35 (17%)

41(19%)

22(10%)

39(18%)

30(14%)

N = 16(8%)

0-7d 8d- 1m 1m - 6m 6m -1y 1y - 5y 5y - 10y >10y

0

5

10

15

20

25

30

40

Children (n=111) Adults (n=211)

15 (14%)

17 (15%)

13 (12%)

11(10%)

28(25%)

14 (13%)

N = 13(12%)

0-7d 8d- 1m 1m - 6m 6m -1y 1y - 5y 5y - 10y >10y

0

5

10

15

20

25 35

30

65

24TH

ANZLT REGISTRY

R E P O R T


Section 5Cause of Patient Death

Section 5

SECTION 5 : CAUSE OF PATIENT DEATH

24TH

ANZLT REGISTRY

R E P O R T


Causes of Death

30.


All Patients n = 1093

Operative

Respiratory

Cerebrovascular

Cardiovascular

Sepsis

Malignancy - recurrent

Malignancy - de novo

Recurrent HBV / HCV

Rejection

Other

Miscellaneous

Gastrointestinal

Graft failure

*

*

See Appendix V for details *

9%

14%4%

6%

7%

8%

2%

15%

10%

11%

8%

6%

24TH

ANZLT REGISTRY

R E P O R T


Causes of Death in Adultn = 952

31.

Operative

Respiratory

Cerebrovascular

Cardiovascular

Sepsis



Recurrent HBV / HCV

Rejection

Other

Miscellaneous

Gastrointestinal Graft failure

*

*


Causes of Death in Childrenn =141

4%


20%

7%2% 4%

15%

7%

4%

21%7%

10%

7%

15% 6%

6%

8%

2%

14%

11%12%

10%

5%

4%

24TH

ANZLT REGISTRY

R E P O R T


32.


Cause of Death by Time Post Transplant

Operative

Respiratory

Cerebrovascular

Cardiovascular

Sepsis



Gastrointestinal

N = 122 (11%) 257 (24%)103 (9%) 130 (12%) 86 (8%) 199 (18%)

Recurrent HBV / HCV

Rejection

Other [graft failure]

Miscellaneous

110 (10%) 86 (8%)

*

*


1y - 5y 5y - 10y 10y - 15y >15y0 - 7d 8d - 1m 1m - 6m 6m - 1y

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

24TH

ANZLT REGISTRY

R E P O R T


33.


N = 24 (17%) 27 (19%)23 (16%) 25 (18%) 9 (6%) 16 (11%) 6 (4%) 11 (8%)

Cause of Death by Time Post Transplant Children (n=141)

Operative

Respiratory

Cerebrovascular

Cardiovascular

Sepsis



Gastrointestinal Recurrent HBV / HCV

Rejection

Other [graft failure]

Miscellaneous

N = 98 (10%) 230 (24%)80 (8%) 105 (11%) 77 (8%) 183 (19%) 104 (11%) 75 (8%)

1y - 5y 5y - 10y 10y - 15y >15y0 - 7d 8d - 1m 1m - 6m 6m - 1y

Cause of Death by Time Post Transplant Adult (n=952)

1y - 5y 5y - 10y 10y - 15y >15y0 - 7d 8d - 1m 1m - 6m 6m - 1y

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

24TH

ANZLT REGISTRY

R E P O R T


Section 6Deceased Donor Information

Section 6

SECTION 6 : DECEASED DONOR INFORMATION

24TH

ANZLT REGISTRY

R E P O R T


0

50

100

150

200

250

300

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

0

50

100

150

200

250

300

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Grafts from deceased donors

34.

Deceased Donation by Year

Cadaveric donors Grafts transplanted

Num

ber

Year

Waiting list - 31 Dec


DCD donors*

QLD NSW/ACT VIC/TAS SA/NT WA NZ TOTAL 2003 34 32/3 29/2 13 15 31 159

2004 30 49/4 35/1 26/1 17 35 198

2005 24 36/8 38/2 17/3 25 21 174

2006 28 34/3 39/6 25 17 24 176

2007 25 36/1 36 19/2 15 32 166

2008 33 40/3 41/5 31/1 25 23 203

2009 35 46/4 36/5 28/2 15 33 204

2010 30 55/8 53/6 18/2 17 32 221

2011 44 52/7 49/3 22/2 20 30 229

2012 46 50/7 52/10 21/6 20 28 240

3 1351* 4 13 17

24TH

ANZLT REGISTRY

R E P O R T


35.


Gra

ft S

urv

ival (

%)

Donor

age (

years

)

Era


1985 - 1989

80

70

60

50

40

30

20

10

0

1990 - 1994 1995 - 1999 2000 - 2004 2005 - 2009

Donor Age by EraN = 3899

Graft Survival by Donor AgeN = 4097

2010 - 2012

100

90

80

70

60

50

40

30

20

10

0

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 24

P <0.001

Donor age group

>65y

0.01-10y11-30y31-50y51-60y61-65y

n= 213

n= 192n= 1403n= 1445n= 639n= 205

n = 96 593 728 869 923

28.6y

36.4y40.0y

43.9y 45.2y

N = 3899Median Age: 39.2yRange: 3d - 84.3y

P < 0.001

690

20.3y

23 25

24TH

ANZLT REGISTRY

R E P O R T


Section 7L i v i n g D o n o r T r a n s p l a n t a t i o n

Section 7

SECTION 7 : LIVING DONOR TRANSPLANTATION

24TH

ANZLT REGISTRY

R E P O R T


36.

Living Donor TransplantationN = 70

SECTION 7 : LIVING DONOR TRANSPLANTATION

Surv

ival (

%)


Donor age

Median

Range

Mother

Father

Son

Daughter

Grandmother

Grandfather

Sister

Brother

Aunt

Family friend

Cousin

Spouse

Donor gender

Male

Female

Child [n=63] Adult [n=14]

-

34.7y

20.1 - 54.5y

-

15

31

-

-

1

1

-

2

6

5

2

-

-

30.3y

22.8 - 44.2y

-

-

-

4

1

-

-

3

3

-

1

-

1

-

38

25

-

9

5

All [n=77]

-

33.8y

20.1 - 54.5y

-

15

31

4

1

1

1

3

5

6

6

2

1

-

47

30

Recipient Age Group

*

* 1 x whole liver domino transplant

90

80

70

60

50

40

30

20

10

0

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 23

100

(71 patients received LD graft as first graft)Patient

Graft o nd rd(All grafts n= 77 [71 x 1 , 5 x 2 , 1 x, 3 ])

Donor relationship

22

24TH

ANZLT REGISTRY

R E P O R T


Section 8W a i t i n g L i s t

Section 8

SECTION 8 : WAITING LIST

24TH

ANZLT REGISTRY

R E P O R T


Waiting List Activity[ Data 1/1/08 - 31/12/12]

37.


Outcome of Initial Urgent Listing

[* Patient decline, Malignancy, Drug Use, Infection, Further investigations, Medical]

TRANSPLANTED

IMPROVED

DIED / TOO SICK

OTHER TREATMENT

2008

(n=13)

3 9

3 2

2009

(n=17)

7 6

- -

2010

(n=19)

13

1

5

-

OUTCOME

}46% }65% }74%

2011

(n=15)

12

-

3

-

}80%11

2

3

-

}81%

Listed at 1 January

New listings

Transplant

Activity

Still listed at 31 Dec

OUTCOME

TOTAL

Died on list

Too sick

Tumour progression

Improved

Other

TOTAL 2012

539

Delisted

Adult

121 [26%]

160

464

28

14

10

15

16

Paediatric

47 [63%]

22

75

1

2

-

2

1

2012

83 [18%] 6 [8%]

268 [50%]

182 [34%]

89 [16%]

}[10%]29

17

1610

17

199

290

229 [47%]

169 [34%]

489

48

14

7

15

11

2008

}14%

96 [20%]

*

9

1

3

-

OUTCOME

175

335

248 [49%]

194 [38%]

510

12

12

12

16

12

2010

}8%

68 [13%]

169

335

228 [46%]

175 [34%]

504

32

17

8

18

26

2009

}14%

101 [20%]

*

2

1

-

-

1 active

31/12/11

24TH

ANZLT REGISTRY

R E P O R T

194

336

253 [49%]

192 [36%]

530

17

17

20

12

19

2011

}8%

85 [13%]

*

192

-

106

45

192

11

8

5

9

8

-

347

162

137

347

18

8

5

8

9

41 48

}11% }4%


2012

CATEGORY 1

N=16 Adultn=13

Paediatricn=3

TRANSPLANTED

IMPROVED

DIED / TOO SICK

OTHER TREATMENT

2008

(n=24)

20 18

1 1

2009

(n=21)

3 2

- -

2010

(n=30)

23

5

1 / 1

-

OUTCOME

}83% }90% }93%

2011

(n=28)

22

2

3

}86%14

3

1

}89%8

1

1

-

6

2

-

2012

CATEGORY 2

N=19 Adultn=10

Paediatricn=9

1 active

31/12/12

1 active

31/12/12

Outcome by Blood Group

Waiting Time to Transplant 2012

A O B AB TOTAL

n=

Not transplanted

Transplanted

210 (39%) 234 (43%) 67 (12%) 27 (5%) 539

Blood Group

101 125 33 11 271

109 (52%) 109 (47%) 34 (51%) 16 (59%) 268

*

**

* % of total number listed

** % of blood group

38.


Blood Type

OBABA

Waiti

ng T

ime (

Month

s)

6

4

2

0

16

14

12

8

10

26

24

22

18

20

36

34

32

28

30

38

-2

69d95d 116d119dMedian

n= 109 (41%) 109 (41%)34 (13%) 16 (6%)

P= NS

24TH

ANZLT REGISTRY

R E P O R T


Waiting Time by Outcome

39.


Waiti

ng T

ime (

Month

s)

Patient Outcome

Waiting Time by Outcome & Blood Group

Waiti

ng T

ime (

Month

s)

Blood Type

Listed 2012Waiting

Listed 2012TransplantListed 2012

DelistedListed pre '12

Waiting

Listed pre '12

TransplantListed pre '12

Delisted

9

6

3

0

21

18

12

15

33

30

24

27

45

42

36

39

54

48

51

642

0

16

14

12

8

10

26

2422

1820

3634

32

2830

38

-3

57

-2

63

60

69

66

48

4644

4042

AB B OA

5052

54565860

24TH

ANZLT REGISTRY

R E P O R T

Median 296d 275d

46d 36d96d

627d

Median waiting time to transplant= 110d (0-73m)

Median waiting time listed patients 31/12/12

= 159d (1d-72m)

72

Median= 117d 45d 107d 154d

Transplanted

Not transplanted

Patient Outcome


Section 9L i v e r T r a n s p l a n t a t i o n a n d C a n c e r

Section 9

SECTION 9 : LIVER TRANSPLANTATION AND CANCER

24TH

ANZLT REGISTRY

R E P O R T


Cancer in Liver Transplant Recipientsn = 3980

40.


Liver Cancer as Primary Diagnosisn= 3980

24TH

ANZLT REGISTRY

R E P O R T

At Tx

Liver Cancer as Primary Diagnosis 295 (7%)

Liver Ca as a Secondary Diagnosis 471 (12%) 473 Ca

Total 766 (18%)

Post Tx

Recurrent Liver Ca 113(3% of all pts, 16% of pts with Ca at Tx)

De Novo Ca 295 (7%) 309 Ca

Skin Ca 984 (25%) 3809 Ca

Total 1392 (35%)

Multiple Ca 555

Pre-Tx cancer developed de novo cancer 25 (3% of pts with Ca at Tx)

Transferred from Donor 2

Developed non skin Ca < 90days 9

n = 3980

TYPE OF CA No DIEDDIED OF THIS

CA

HEPATOCELLULAR CA 259 64 34 (36%)

HEPATOBLASTOMA 19 5 4 (67%)

FIBROLAMELLAR 6 5 2 (40%)

CARCINOID 4 4 4 (100%)

CHOLANGIOCARCINOMA 2 1 1 (50%)

ANGIOSARCOMA 1 1 1 (100%)

EPITHELOID HAEMANGIOENDOTHELIOMA 2 0 0

GASTRINOMA 1 1 1 (100%)

PANCREATIC ISLET CELL 1 1 1 (100%)

TOTALS 295 (7% of pts)82 (28% of

those with PCa)

48 (16% of those with

PCa)


Overall SurvivalPrimary Liver Cancern = 295 (7% of patients transplanted)

41.


Overall SurvivalPrimary Liver Cancern =295/3980 (7%)

24TH

ANZLT REGISTRY

R E P O R T

0

20

40

60

80

100

0 5 10 15 20

Years Post Tx

%S

urv

ivin

g

n = 295 (7% of pts transplanted)

5y 10y 15y

No at risk 95 28 9

Actuarial Survival % 70 57 49

0

20

40

60

80

100

0 5 10 15 20

Years post Tx

HCC(n=259)

Other(n=9)

Fibromellar(n=6)

Hepatoblastoma (n=19)

CC(n=3)

%S

urv

ivin

g

p<0.05


Primary Liver Cancer Actuarial Survival Summaryn = 3980

42.


Liver Cancer as Primary Diagnosisn = 295

24TH

ANZLT REGISTRY

R E P O R T

1yr 5yr 10yr 15yr

HCC (n=259)n 217 84 22 6

% 91 72 60 60

Other (n=9)n 9 4 2 2

% 89 44 15 15

Hepatoblastoma(n=19)n 18 6 3 2

% 95 75 50 50

Fibrolamellar (n=6)n 6 4 4 2

% 83 63 63 21

CC (n=3)n 23

% 50

9

2

18

43

67

120

8

1811 10

18 17

0

20

40

60

80

100

120

140

1985 - 1989 1990 - 1994 1995 - 1999 2000 - 2004 2005-2008 2009-2012

HCC(n=259)

Other (n=83)


Liver Cancer as a Secondary Diagnosisn = 3980

43.


Primary Liver Cancer Incidence and Mortality

* 1 patient had 2 secondary cancers

24TH

ANZLT REGISTRY

R E P O R T

0

5

10

15

20

25

30

35

40

45

50

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Primary Malignancy(n=295)

Mortality (n=153)

No DiedDied of This

Cancer

HEPATOCELLULAR CA* 426 122 33 (27%)

CHOLANGIO CA 34 25 13(52%)

HEPATOBLASTOMA* 3 1 0

LAMELLA VARIANT 4 2 0

OTHER 6 4 2 (50%)

Total473* in 471pts (12%)

152 (32% of pts with SCa)

48 (10% of pts with SCa)


Overall SurvivalLiver Cancer as a Secondary Diagnosis

44.


Liver Cancer as a Secondary Diagnosisn = 3980

24TH

ANZLT REGISTRY

R E P O R T

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Years Post Tx

n=471/3980 (12%)

5y 10y 15y

No at risk 207 86 18

Actuarial Survival % 72 62 42

%S

urv

ivin

g

0

20

40

60

80

100

0 2 4 6 8 10 12 14 16 18

% Surviving

Years Post Tx

Lamella Variant (n=4)

Hepatoblastoma=3

HCC(n=426)

CC(n=34)

Other(n=6)


45.


Secondary Liver Cancer Actuarial Survival Summaryn =473/ 3980 (12%)

Liver Cancer as a Secondary DiagnosisIncidence and Mortalityn=473/3890 (12%)

24TH

ANZLT REGISTRY

R E P O R T

1yr 5yr 10yr 15yr

HCC (n=385)n 305 178 65 7

% 79 46 17 2

CC (n=33)n 27 10 5 2

% 82 30 15 6

Hepatoblastoma (n=3)n 3 2 2 1

% 100 67 67 33

Fibrolamellar (n=4)n 4 4 2 2

% 100 100 50 50

Other (n=7)n 7 4 1 0

% 100 57 14 0

0

5

10

15

20

25

30

35

40

45

50

19

85

19

86

19

87

19

88

19

89

19

90

199

1

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

200

1

200

2

20

03

20

04

20

05

20

06

200

7

20

08

20

09

20

10

20

11

201

2

Secondary Malignancy (n=473)

Mortality (n=157)


Liver Cancer (Primary or Secondary Diagnosis) n = 3980

46.


Patient Actuarial SurvivalBenign Disease vs Pre Transplant Liver Malignancyn = 3980

* 1 patient had 2 secondary cancers

24TH

ANZLT REGISTRY

R E P O R T

TYPE OF CA NO DIED DIED OF THIS CA

HEPATOCELLULAR CA* 685 188 67 (41%)

CHOLANGIOCARCINOMA 36 27 15 (53%)

HEPATOBLASTOMA* 22 6 4 (66%)

FIBROLAMELLAR 10 5 2 (40%)

CARCINOID 4 4 4 (100%)

ADENOCARCINOMA 4 3 1 ((20%)

EPITHELOID HAEMANGIOENDOTHELIOMA 3 0 0

GASTRINOMA 1 1 1 (100%)

PANCREATIC ISLET CELL 1 1 1 (100%)

ANGIOSARCOMA 2 2 2 (100%)

TOTALS768 (19% of

pts)237 (31%of

those with Ca)97 (13% of those with Ca

at Tx)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

Years Post Tx

% Surviving

Benign disease (n=3212)

Malignant Disease (n=768)

p=0.000

5y 10yr 15yr 20yr

Benign Disease

n 1960 1236 655 237

% Surviving 83 74 67 56

Malignant Disease

n 301 113 26 6

% Surviving 71 60 44 28


47.


De Novo Non Skin CancerNo at Risk = n = 3980

Time to 1st De Novo Non Skin Cancern = 3980309 cancers in 295 pts (7% of all pts)

24TH

ANZLT REGISTRY

R E P O R T

Fifteen patients also had a liver cancer at Tx; * 11 patients had more than 1 de novo malignancy

No MaleFemal

e Age of pts (yrs)Time to diagnosis

(mths)Died of This

Cancer

Alimentary* 114 83 31 13 – 78 (m 57) 3 – 232 (m 107) 52 (46%)

Lymphoma* 79 49 30 1– 70 (m 49) 1 – 214 (m 64) 28 (35%)

Genitourinary* 39 26 13 21 – 75 (m 60) 2 – 231 (m 87) 4(10%)

Breast 23 - 23 30 – 74 (m 53) 11 –241(m 112) 9 (39%)

Respiratory 26 21 5 29 – 75(m 58) 7 – 212(m70) 19(73%)

Kaposi’s 5 4 1 32 – 65 (m 51) 2 – 48 (m 21) 0

Endocrine 9 4 5 36 – 70 (m 55) 35 – 213 (m89) 3 (33%)

CNS 7 5 2 16 – 75 (m 57) 14 –211(m118) 6(86%)

Leukaemia 3 1 2 3.– 50 (m 30) 16 – 44 (m 30) 0

Miscellaneous 4 2 2 62 – 73 (m 65) 6 – 234 (m 75) 1 (25%)

Total*309ca in

295pts 195 114 1 – 78 (m 53) 1 – 242 (m 72)122 (41% of pts with Ca)

0

5

10

15

20

25

30

0-3m 3-12m 1-3yr 3-5yr 5-10y >10y

Alimentary Tract

Breast

CNS

Endocrine

Genitourinary

Kaposi's sarcoma

Leukaemia

Lymphoma

Miscellaneous

Respiratory


48.


De Novo Non Skin Cancern = 309/3980(8%)

De Novo Non Skin Cancer vs All Patientsn = 3980

24TH

ANZLT REGISTRY

R E P O R T

0

20

40

60

80

100

0 5 10 15 20 25

Years Post Tx

% Surviving

All pts.(n=3685)

De Novo(n=295)

p<0.0001

5y 10yr 15yr 20yr

Othersn 2058 1216 611 220

% Surviving 81 74 67 58

De Novon 204 133 70 23

% Surviving 76 58 43 25

Breast, 23. 7%

CNS, 7, 2%Endocrine, 9.3%

Genitourinary, 39, 13%

Kaposi's, 5, 2%

Leukaemia, 3, 1%

Lymphoma, 79. 26%

Miscellaneous, 4. 1%

Respiratory, 26, 8%

Upper GI, 23%

Lower GI, 69 %

Pancreas, 8, 8%

Alimentary,114 37%


49.


De Novo Non Skin CancerAlimentary Tract Incidencen = 114/309 cancers (37%)

Pre Transplant Liver Disease andDe Novo Non Skin Cancer n = 309/3980 (7%)

24TH

ANZLT REGISTRY

R E P O R T

59

11 11

25

8

0

10

20

30

40

50

60

70

Colorectal Liver Stomach Upper GI Pancreas

21

4

35

6

1 1

Lymphom

a

Breast

Alimentary

Genitourinary

Kaposi's

Leukaemia

1

10

1 1

Lymphom

a

Alimentary

Genitourinary

Respiratory

PSC + Auto-immune - 73/309 24% of all de novo

HBV - 13/3094% of all de novo

p=nsP<0.0001


50.


Pre Transplant Liver Disease andDe Novo Non Skin Cancer n = 309/3980 (7%)

Primary Liver Disease andDe Novo Non Skin Cancern = 309/3980 (7%)

24TH

ANZLT REGISTRY

R E P O R T

13

22

86

1 1 1

Lym

ph

om

a

Alim

en

tary

Re

spira

tory

Ge

nito

urin

ary

Ka

po

si's

Le

uka

em

ia

CN

S

HCV - 57/30918% of all de novo

20

5

7

4

21

Alim

en

tary

Lym

ph

om

a

Re

spira

tory

Ge

nito

urin

ary

CN

S

Oth

er

Alcohol –39/30913% of all de novo

0

10

20

30

40

50

60

PS

C

Alco

hol

HC

V

PB

C

Pre

Tx C

ance

r

Auto

imm

une

HB

V

Meta

bolic

Fulm

inant

Bilia

ry Atre

sia

Oth

er

HC

V_H

BV

Respiratory

Other

Lymphoma

Leukaemia

Kaposi's sarcoma

Genitourinary

Endocrine

CNS

Breast

Alimentary Tract

PSC p<0.0001


51.


Skin Ca Post Ltxn = 3980

**555 pts had multiple skin cancer types

Time to Melanoma Skin Cancer Developmentn = 29(0.7% of all pts)

Cumulative Risk of Diagnosis of Cancer Following Liver Tx. 1985-2012

24TH

ANZLT REGISTRY

R E P O R T

Type of Skin Cancer

Pts Cancers

BCC 333 1071

SCC 364 1532

Melanoma 29 29

Total 948 (26% of all pts)** 3809

n =3980

1

8

12

7

3-12m 1-5yrs 5-10yrs >10yrs

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Patients at Risk (3980)

Years Post Tx

Any CaSkinNon skin (includes recurrent primary and secondary liver cancer)De Novo Non skinAge-Matched Gen. Pop


Appendix IAppendix I

APPENDIX

Liver Transplant Units of Australia and New Zealand

South Australian Liver Transplant Unit

Flinders Medical Centre

Flinders Drive

BEDFORD PARK SA 5042

http://www.flinders.sa.gov.au/flinders_centre_for_digestive_health/

WA Liver Transplantation Service

Sir Charles Gardiner Hospital

Verdun Street

NEDLANDS WA 6009

New Zealand Liver Transplant Unit

Auckland City Hospital

Park Road

Auckland

New Zealand

Http://www.nzliver.org/

The Children's Hospital at Westmead

Hawkesbury Road

WESTMEAD NSW 2145

The Royal Children's Hospital

Flemington Road

PARKVILLE VIC 3052

The Royal Children's Hospital

Bowen Bridge Road

HERSTON QLD 4029

Australian National Liver Transplant Unit

Royal Prince Alfred Hospital

Missenden Road

CAMPERDOWN NSW 2050

Email: [email protected]

http://www.sswahs.nsw.gov.au/Gastro/LiverTransplant/default.htm

Victorian Liver Transplantation Unit

The Austin Hospital

Studley Road

HEIDELBERG VIC 3084

http://www.austin.org.au/Content.aspx?topicID=397

Queensland Liver Transplant Service

Princess Alexandra Hospital

Ipswich Road

WOOLLOONGABBA QLD 4102

and

and

and

52.

24TH

ANZLT REGISTRY

R E P O R T


Appendix IIAppendix II

APPENDIX

53.

ANZLTR PRIMARY Diagnosis Metabolic disorders by Age Group

-1 Antitrypsin deficiency

Crigler-Najjar

Familial amyloid polyneuropathy

Glycogen storage disease

Haemochromatosis

Homozygous Hypercholesterolemia

Idiopathic copper toxicosis

Indian childhood cirrhosis Other

Primary hyperoxaluria

Tyrosinemia Urea cycle disorders Wilsons disease

Total

Bile acid synthesis disorder Protein C deficiencyMethylmalonic acidemiaFamilial immunodeficiencyMitochondrial diseaseAmyloidosisMaple syrup urine diseasePorphyriaPropionic acidemia

36

9

0

2

3

5

1

1

9

7

4

18

8

103

48

1

31

3

28

2

0

0

5

6

0

4

28

156

Age group

Primary Diagnosis

84

10

31

5

31

7

1

1

14

13

4

22

36

259

*

**

OTC deficiency 13Citrullinemia 4Argininosuccinic aciduria 4Carbamyl phosphate synthetase deficiency

* **

Child Adult

Total

24TH

ANZLT REGISTRY

R E P O R T


Appendix IIIAppendix III

APPENDIX

54.

ANZLTR PRIMARY Diagnosis - Other by Age Group

Coach syndromeBiliary sclerosisCornelia De Lange SyndromeHepatic Lymphangiomatosis

Alagille syndrome

Alagille non-syndromic

Benign liver tumour - Adenomatosis

Benign liver tumour - Hemangioma

Caroli's disease / congenital hepatic fibrosis

Choledocal cyst

Cholestatic disease-Other

Chronic Budd Chiari

Congenital biliary fibrosis

Ductopenia

Granulomatous hepatitis / sarcoidosis

Histiocytosis X

Liver Trauma

Neonatal hepatitis

Nodular regenerative hyperplasia

Non alcoholic fatty liver (NAFLD or NASH)

Polycystic Liver disease

Polycystic liver and kidney disease

Progressive familial intrahepatic cholestasis(PFIC)

Secondary biliary cirrhosis

Secondary biliary cirrhosis - Hepatolithiasis

Secondary biliary cirrhosis - Cystic fibrosis

Other - specify

Total

24

2

0

0

3

2

1

1

0

1

0

4

0

4

0

0

0

0

20

2

0

11

8

83

6

0

2

2

19

2

7

30

2

3

4

0

1

0

7

81

19

9

5

12

4

17

22

254

30

2

2

2

22

4

8

31

2

4

4

4

1

4

7

81

19

9

25

14

4

28

30

337

Primary DiagnosisAge group

#

Child Adult

Total

# Vanishing bile duct syndrome Haemangiotelangiectasia Veno-occlusive disease Chronic Active Hepatitis A Non-cirrhotic portal hypertension Kassabach-Merritt syndrome Arterial-venous malformation Hereditary haemorrhagic telengectasia / OWRD Oriental cholangio hepatitis

24TH

ANZLT REGISTRY

R E P O R T


Appendix IVAppendix IV

APPENDIX

55.

ANZLTR PRIMARY Diagnosis Fulminant Hepatic Failure by Age Group

Acute - Budd Chiari

Acute - Wilson's

Acute - -1 -AAT

Acute Autoimmune hepatitis

Acute Unknown / unspecified

Acute - Paracetamol

Acute - Other drugs

Acute Herbs / mushrooms

Acute - Hepatitis A

Acute - Hepatitis B

Acute - Non A-E

Acute - Hepatitis E

Acute - Post liver resection

Subacute - Budd Chiari

Subacute - Wilson's

Subacute Autoimmune hepatitis

Subacute - Drug / Herbs

Subacute - Unknown / unspecified

Subacute - Hepatitis A

Subacute - Hepatitis B

Subacute - NonA - NonB

Total

0

7

2

0

43

3

3

0

0

0

6

0

1

1

2

1

1

5

0

0

0

75

2

16

0

6

89

15

21

6

3

56

15

1

1

2

4

14

10

31

2

16

1

311

2

23

2

6

132

18

24

6

3

56

21

1

2

3

6

15

11

36

2

16

1

386

Primary Diagnosis

Children Adult

TotalAge group

24TH

ANZLT REGISTRY

R E P O R T


Appendix VAppendix V

APPENDIX

56.

ANZLTR Causes of Patient death

Non thrombotic infarction

Primary non function

Massive haemorrhagic necrosis

Recurrent disease (ALD, PSC, CAH:AI)

De novo Hep C

Biliary Complications

Other (PNC, immune hepatitis, outflow obstruction)

7

14

21

Graft failure - other

Children Adult

TotalAge group

Hepatic artery

Portal vein

Hepatic vein

Vascular thrombosis

4

2

1

8

6

-

12

8

1

17

Renal Failure

Graft vs Host disease

Social

Sudden death (cause unknown)

Other (Hyperkalaemia,motor neurone disease diabetes complications, drug reaction, progression FAPessential thrombocythemia)

5

48

53

Miscellaneous Children Adult

Multiorgan failure

(accident, suicide,non-compliance, Rx withdrawn)

1 29

30

-

7

7

1

14

15

1

23

24

2

20

22

-

2

3

11

7

8

2

14

15

28

69

97

TOTAL

10

141

151

TOTAL

-

17

0

17

3

4

4

-

3

21

4

24TH

ANZLT REGISTRY

R E P O R T


AUSTRALIA & NEW ZEALAND - Sydney Local Health District 24th... · The Australia and New Zealand...

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