Australian National Liver
Transplantation Unit
© copyright ANLTU Data to 31 December 2016
0
10
20
30
40
50
60
70
80
90
100
110
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
2013
2014
2015
2016
Child (n = 333)
Adult (n = 1342)
Data to 31 December 2016
Data to 31/12/2016 © copyright ANLTU
Contents Preface ......................................................................................................................................... i
Summary ...................................................................................................................................... i
ASSESSMENT INFORMATION ............................................................................................................................. 1
Allocation of Assessed Adults/Children ...................................................................................... 2
Patients Considered Unsuitable for Transplantation (Adults) .................................................... 2
Comparison Over Time Of Patients Assessed ............................................................................. 3
Waiting List Activity ..................................................................................................................... 4
Urgent Listings ............................................................................................................................ 5
Age and Waiting Time of Transplant Recipients (Primary Grafts) .............................................. 6
DONOR INFORMATION ...................................................................................................................................... 8
Deceased Donor Offers ............................................................................................................... 9
DBD Donor Offers...................................................................................................................... 13
DCD Donor Offers ...................................................................................................................... 13
Allocation of Accepted and Utilised Deceased Donor Offer Livers 2016 ................................. 14
Living Donor Procedures – Paediatric & Adult .......................................................................... 14
Deceased Donor Age by Era (Median) ...................................................................................... 15
Donors over 50 years ................................................................................................................ 15
Deceased Donor Cause of Death .............................................................................................. 16
RECIPIENT DEMOGRAPHICS ............................................................................................................................ 18
Patient Age at Transplant.......................................................................................................... 19
Primary Hepatic Disease ........................................................................................................... 19
Chronic Viral and Auto-Immune Hepatitis ................................................................................ 21
Fulminant Hepatic Failure as Primary Indication Treated by Liver Transplantation ................ 22
HCC and Associated Disease ..................................................................................................... 23
NASH/NAFLD by Era .................................................................................................................. 24
Indication For Secondary Transplantation ................................................................................ 25
PERIOPERATIVE DATA ...................................................................................................................................... 26
Mean/Median Hospital Stay ..................................................................................................... 27
Red Cell Usage ........................................................................................................................... 27
Graft Ischaemic Time, Operation Duration and Red Cell Utilisation ........................................ 27
OUTCOME DATA .............................................................................................................................................. 28
Patient Survival ......................................................................................................................... 29
Primary Disease and Outcome .................................................................................................. 33
Status at Transplant vs Patient Outcome ................................................................................. 34
Chronic HBV Outcomes ............................................................................................................. 36
Chronic HCV Outcomes ............................................................................................................. 37
Donor Age vs Primary Graft Outcome ...................................................................................... 40
Steatosis vs Graft Outcome (Adults) ......................................................................................... 41
Graft Survival ............................................................................................................................. 42
Split vs Reduced vs Whole Grafts ............................................................................................. 45
Auxiliary Transplant Survival ..................................................................................................... 47
Cause of Death .......................................................................................................................... 48
Cause of Graft Failure ............................................................................................................... 53
CANCER AND TRANSPLANTATION ................................................................................................................... 57
Malignancy at Transplantation ................................................................................................. 58
De Novo Non Skin Cancer Post Transplant ............................................................................... 61
Pre Transplant Liver Disease and De Novo Non Skin Cancer .................................................... 62
Cumulative Risk of Diagnosis of Cancer .................................................................................... 64
Data to 31 December 2016 © copyright ANLTU i
Preface
The 30 year anniversary of the first liver transplant occurred during 2016. Since January 1986
1675 liver transplants on 1544 patients have been performed at ANLTU.
In 2016, 98 new, 14 secondary and 1 tertiary orthotopic liver transplant procedures were
performed within the ANLTU (27 – The Children’s Hospital at Westmead; 86 – Royal Prince Alfred
Hospital). This included the ongoing usage of split liver allografts and the use of extended criteria
donor liver allografts, which maximise the limited donor resources available.
The staff within the ANLTU would like to thank the members of the departments within Royal
Prince Alfred Hospital and Sydney Local Health Network who have helped contribute to the
success of the program in the past year. This includes Haematology, Biochemistry, other
Laboratory services, Blood Bank, Department of Pathology, Department of Renal Medicine,
Intensive Care Unit, Operating Room, Department of Psychiatry, Department of Cardiology,
Department of Respiratory Medicine, Dietetic Department, Department of Social work,
Department of Anaesthesia, the Casemix unit and all the other people who have not been
specifically mentioned.
We would also like to thank the other departments within the Children’s Hospital at Westmead,
who have helped contribute to the success of the paediatric programme. These include the
membership of Department of Anaesthesia, the Intensive Care Unit, Laboratory services staff,
Department of Social Work, Department of Nutrition and other medical departments.
The staff of the Australian Red Cross Blood Service are also acknowledged for their assistance
during the year.
Finally, without the generosity of the deceased organ donors and their families, liver
transplantation would not be able to proceed at this level. Hence we give our thanks to them as
well as to the team at Donate Life NSW, Kogarah.
Professor Geoff McCaughan
Dr Deborah Verran
Dr Michael Crawford
Gavin Lackey
Data to 31 December 2016 © copyright ANLTU ii
Summary
Summary
There are several key issues to report.
1. In 2016 there were:
113 orthotopic liver transplant procedures
107 new listings on the Waiting List
40 patients on the Waiting List at the end of the year
2 Donations after Circulatory Death
8 Paediatric Donors
2. In 2016, 98 new, 14 secondary and 1 tertiary orthotopic liver transplant procedures
were performed, 27 of which were Paediatric and 86 were Adult.
3. Between January 1986 to December 2016, 1675 liver transplants were performed on
1544 patients, of which 1257 and 287 recipients were adults and children, respectively.
4. The number of transplants per year continues to be related to the deceased donor rate.
5. In 2016, 16 patients (9%) on the waiting list were subsequently withdrawn due to
advanced and/or extra-hepatic disease. Five patients improved whilst on the waiting
list.
6. The movement of patients on and off the waiting list continues to be dynamic.
7. The average waiting time for adults in all blood groups remains variable depending on
blood group.
8. The median deceased donor age has increased from 30 years (1986 – 1996) to 45 years
(2007 – 2016). In 2016 there were seven deceased donors over the age of 70 years.
9. The median age for adult recipients has increased from 46.7 years (1986 – 1996) to now
stand at 52.1 years. The median age for child recipients has decreased from 3.7 years
(1986 – 1996) and now stands at 2.2 years.
10. HCV infection has been an increasing primary and secondary indication for liver
transplantation in adults. In the period 1986 – 1996 12% of adults had this diagnosis
compared to 39% in 2007 – 2016.
11. Hepatocellular carcinoma has also become an increasingly common primary and
secondary indication for liver transplantation, with 33% of the adult recipients having a
diagnosis of HCC in the five year period 2012 – 2016.
12. The overall patient survival rate over the past 2 years was 93% at one year.
Data to 31 December 2016 © copyright ANLTU 1
ASSESSMENT INFORMATION
Data to 31 December 2016 © copyright ANLTU 2
Allocation of Assessed Adults/Children
© copyright ANLTU Data to 31 December 2016
Allocation of Patients Accepted for Assessment
Accepted68%
Deferred11%
Unsuitable19% Died Pre-
List2%
Adults (n = 2452)
Accepted89%
Deferred4%
Unsuitable7%
Children (n = 374)
Patients Considered Unsuitable for Transplantation (Adults)
© copyright ANLTU Data to 31 December 2016
Patients Considered Unsuitable for Transplantation2452 Adults have been assessed since 1985
Reason Adults
Too Advanced + extra-hepatic disease 171 37
Tumour Progression + Tumour (extra-hepatic spread) 76 16
Good prognosis 66 14
Psychological 15 13
Alcohol 57 12
Patient’s wish 24 5
Alternative therapy 7 1
Age 5 1
Condition improved 2 0.4
Logistics 1 0.2
Total 470 100%
Data to 31 December 2016 © copyright ANLTU 3
Comparison Over Time Of Patients Assessed
Comparison Over Time of Patients Assessed
© copyright ANLTU Data to 31 December 2016
1985 - 1996
Accepted48%
Deferred18%
Unsuitable34% Died
Pre-List
0.1%
Adults (n = 739)
Accepted73%
Deferred11% Unsuitable
16%
Children (n = 126)
© copyright ANLTU Data to 31 December 2016
1997 - 2006
Accepted64%
Deferred15%
Unsuitable19%
Died Pre-List2%
Adults (n = 914)
Accepted94%
Deferred2%
Unsuitable4%
Children (n = 125)
© copyright ANLTU Data to 31 December 2016
2007 - 2016
Accepted90%
Deferred1%
Unsuitable5%
Died Pre-List4%
Adults (n = 799)
Accepted99%
Unsuitable1%
Children (n = 123)
Adult patient acceptance rate has increased from 48% in the period of 1985 – 1996 to 90% in
2007 – 2016.
Child patient acceptance rate has increased from 73% in the period of 1985 – 1996 to 99% in
2007 – 2016.
Data to 31 December 2016 © copyright ANLTU 4
Waiting List Activity
© copyright ANLTU Data to 31 December 2016
Waiting List Activity
Year
Listed at
Start of
Year
New
ListingsTotal
Pts
Tx
Died
Pre Tx
Withdrawn Total
Withdrawn/
Mortality
ImprovedListed at
End of YearTumour
ProgressedOther
2007n 46 95 141 54 19 2 2 23 2 63
% 38 13 1 1 16 1
2008n 63 76 139 59 25 2 5 32 5 43
% 42 18 1 3.5 23 3.5
2009n 43 97 140 59 11 3 5 19 8 54
% 42 8 2 3.5 13.6 5.7
2010n 54 98 152 77 6 4 2 12 2 61
% 51 4 3 1 8 1
2011n 61 82 143 71 9 5 2 16 4 52
% 50 6 3 1 11 3
2012n 52 104 156 75 15 2 9 26 2 53
% 48 10 1.3 6 17 1.3
2013n 53 113 166 80 15 5 11 31 3 52
% 48 9 3 7 19 2
2014n 52 112 164 76 5 1 14 20 4 64
% 46 3 0.6 9 12 2
2015n 64 122 186 98 3 3 13 19 1 68
% 53 2 2 7 10 .5
2016n 68 107 175 107 5 8 3 16 9 40
% 61 2 3 1 9 5
© copyright ANLTU Data to 31 December 2016
63
43
54
61
52
53
52
64
68
40
0 10 20 30 40 50 60 70 80
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Patients on Waiting List at the end of Calendar Yea r
Data to 31 December 2016 © copyright ANLTU 5
© copyright ANLTU Data to 31 December 2016
16
23
14
8
11
1719
1210 9
1
3.5
6
1
3
1
2
2
0.5
5
0
5
10
15
20
25
30
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Improved
Withdrawn/Mortality
% Patients Withdrawn from Waiting List
Urgent Listings
© copyright ANLTU Data to 31 December 2016
Urgent Listings 2016
Number of Patients Listed as
Urgent
Share
35Cat 1 Cat 2 Total
Transplanted 2 5 9 16
Died Pre-Transplant 1 1
Permanently Delisted 1 1
Died Post-Transplant on waiting list 2 2
Total 3 7 10 20
Data to 31 December 2016 © copyright ANLTU 6
Age and Waiting Time of Transplant Recipients (Primary Grafts)
© copyright ANLTU Data to 31 December 2016
Age of Transplant Recipients (Primary Grafts)
n 69 91 126
Median 3.7 2.4 1.4
Mean 5.4 4.2 3.6
Children
n 286
Median 2.2 years
Mean 4.2 years
Range 0.1 – 15.6 years
n 280 402 574
Median 46.7 50.7 54.6
Mean 44.3 49.5 52.8
Adults
n 1256
Median 52.1 years
Mean 49.8 years
Range 16.1 – 69.5 years
2030
4050
6070
Age
at T
rans
plan
t - Y
ears
1986 - 1996 1997 - 2006 2007 - 2016
05
1015
Age
at T
rans
plan
t - Y
ears
1986 - 1996 1997 - 2006 2007 - 2016
© copyright ANLTU Data to 31 December 2016
Waiting Time of Transplant Recipients (Primary Graf ts)Children
Median 2.26 months
Mean 5.02 months
Max 76.49 months
Adults
Median 2.43 months
Mean 5.71 months
Max 95.48 months
Median 1.80 6.33 5.17
Mean 3.02 2.39 2.33
Max 14.49 48.10 76.49
Median 0.80 2.82 4.49
Mean 1.32 5.20 8.20
Max 7.80 69.25 95.48
05
1015
20M
onth
s W
aitin
g
1986 - 1996 1997 - 2006 2007 - 2016
05
1015
2025
Mon
ths
Wai
ting
1986 - 1996 1997 - 2006 2007 - 2016
Data to 31 December 2016 © copyright ANLTU 7
© copyright ANLTU Data to 31 December 2016
5.5
8.9 9
3.6
1.6
3.3
9.7
12.7
5.9
11.7
6.6
8
0
2
4
6
8
10
12
14
2007 - 2009 2010 - 2012 2013 - 2016
A
AB
B
O
Adult Mean Months WaitingPrimary Liver Transplantation vs ABO (2007 – 2016)
© copyright ANLTU Data to 31 December 2016
2007 – 2009 2010 – 2012 2012 – 2016 Overall
A 5.5 9.0 8.9 8.3
AB 3.6 1.6 3.3 3.0
B 9.7 12.7 5.9 8.6
O 11.7 6.6 8.4 8.7
Mean 8.7 8.4 7.9 8.2
Adult Mean Months WaitingPrimary Liver Transplantation vs ABO (2007 – 2016)
Data to 31 December 2016 © copyright ANLTU 8
DONOR INFORMATION
Data to 31 December 2016 © copyright ANLTU 9
Deceased Donor Offers
© copyright ANLTU Data to 31 December 2016
46
52 51
66
61
69
74
69
79
101
42 3 4 4
2 2 2
108
1 2 36 5
2 35
8
2
0
20
40
60
80
100
120
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Adult DBD Paediatric DBD Adult DCD
Deceased Adult and Paediatric Donor Organs Used By Year
Since 2000, 93.6% of liver donors were adults (>=15yrs) and 6.4% were paediatric donors.
© copyright ANLTU Data to 31 December 2016
Deceased Donor Offers to NSW 2007 - 2016Donor Type State 2007 - 2009 2010 - 2012 2013 – 2015 2016 Total
DBD
ACT 12 20 24 14 70
NSW 147 194 240 101 682
NT 3 2 3 1 9
NZ 9 10 12 7 38
QLD 23 18 24 19 84
SA 15 9 21 6 53
TAS 4 1 2 1 8
VIC 19 32 20 10 81
WA 8 15 18 7 48
Total BDD Offers 240 303 364 166 1073
BDD Used 137 186 217 103 643
DCD
ACT 6 6 4 1 17
NSW 41 66 49 16 172
NT 1 1 2
NZ 1 1
QLD 2 1 3
SA 1 1
TAS 1 1
VIC 1 7 6 4 18
WA 1 1
Total DCD Offers 48 81 63 24 216
DCD Used 7 15 13 2 40
Total Offers 288 384 427 190 1289
Total Used 144 201 233 105 683
Data to 31 December 2016 © copyright ANLTU 10
© copyright ANLTU Data to 31 December 2016
DBD Donor Offers Declined 201664/167 (38.3%)
Declined at
Offer
Declined at
Hepatectomy
Abnormal LFTs 7
Cirrhosis 3
Donor age 1
Donor history * 15
Donor malignancy - extrahepatic 1
Donor obesity 1
High risk donor for tumour or infection 1
Impaired perfusion/ischaemia 2
Interstate donor not suitable for directed recipient (Urgent Case) 5 1
Liver fibrosis 1
No suitable ABO compatible recipient/No suitable recipient 7
Offer waived for urgent Tx elsewhere 6
Positive virology 1
Steatosis 4
Unstable 2
Vascular issues 1
Other ** 1 4
TOTAL 46 18
© copyright ANLTU Data to 31 December 2016
DBD Donor Offers Declined 201664/167 (38.3%)
*Donor
history
1 Age, Hx HT, diabetes, initially accepted however plaque in HA found on CT.
2Long downtime, heavy drinker, long ischaemic time from WA, raised LFT's. High risk (sexual
activity and prison - NAT neg).
3 Mammalian Protein Allergy with potential anaphylaxis reactions if eating meat.
4 Multiorgan failure.
5 Recent unexplained weight loss, jaundice, IVDU, hep c, downtime.
6 Extended criteria donor unstable, high lactate downtime high risk primary non function.
7 Severe lv dysfunction ef 15%, acidotic , LFTs, ext downtime.
8 High bili (77), low plt, high etoh, likely liver disease, serology hcv pos.
9 Donor history of itp.
10Age, extensive medical hx (cardiovascular), rabdo, downtime, interstate (cold time). No patients
sick enough to risk.
11 History of hydatid disease and pseudooxantheroma elasticum.
12 Technically not possible to retrieve liver due to aortic dissection, massive blood loss.
13 Unusable graft, acidotic, coagulopathic, abnormal lfts, unstable.
14 HCV pos (on nat), hx alcoholic, long cit, ht, chol, smoker.
15Cocaine and probable heroin od, rehab for etoh, heavy drinker, 57 mins downtime, hcv pos,
raised lft's. No patients sick enough to justify risk.
Data to 31 December 2016 © copyright ANLTU 11
© copyright ANLTU Data to 31 December 2016
DCD Donor Offers Declined 201624/26 (92.3%)
Declined at
Offer
Declined at
Hepatectomy
Abnormal LFTs 1
Consent withdrawn/relatives refused consent 1
DCD did not proceed to hepatectomy 7
Donor history * 4
Donor obesity 1
Interstate donor not suitable for directed recipient (Urgent case) 1
No suitable recipient 1
Outside DCD acceptance criteria 5
Steatosis 1 2
TOTAL 15 9
* Donor history 1 DCD and in Tasmania, Vic already turned down.
2Hx of complicated cholecystectomy, biliary leak requiring stents, ERCP's strictures, ongoing
deranged LFTs.
3 HCV +ve Donor/Opiates unsure window period/Polypharmacy.
4 60mins + downtime, unknown cause of death, ischaemic hepatitis, IVDU
© copyright ANLTU Data to 31 December 2016
Enquiries Declined 2016
Declined at
Enquiry
Abnormal LFTs 5
Cirrhosis 2
Consent withdraw/relatives refused consent 4
Donor age 6
Donor history * 19
Donor obesity 1
High risk donor for tumour or infection 5
Interstate donor not suitable for directed recipient (Urgent Case) 1
Known liver disease 1
No suitable ABO compatible recipient 3
No suitable recipient 6
Not suitable for designated recipient 2
Offer waived 1
Outside DCD acceptance criteria 3
Unstable 1
Vascular issues 1
Other ** 10
TOTAL 71
Data to 31 December 2016 © copyright ANLTU 12
© copyright ANLTU Data to 31 December 2016
Enquiries Declined 2016
* Donor
history
1Congenital syndromes, ? Biliary tree malformation with Turners syndrome. DCD. No pts sick enough to
risk.
2 ECMO, high inotropes, downtime 55 mins.
3 Methamphetamine, Sexual contacts, IVDU, 72 mins downtime, LFTs.
4 OOHCA extended downtime abnormal LFTs.
515 days ICU, extensive hx including congenital hrt disease, Eisenmenger syndrome, polycythemia.
Ongoing sepsis ? Source.
6Verbal DCD interstate offer for our Share 35 urgent, simultaneous with BDD offer more suitable. HCV,
logistics, not consented.
7HCV and HBcAg +, IVDU. No patients currently suitable to accept risk. Offered interstate. Nil organs
accepted.
8DCD>50 known vascular disease not seen for many days, rhabdomyolysis, likely hepatic micro emboli, not
medically suitable.
9 Methamphetamine, known IVDU, ETOH.
10 DCD outside criteria (age).
11 HCV and HIV pos never treated. Current IVDU.
12Hx fatty liver, BMI 38, alcohol abuse, raised LFTs. Requested rpt U/S which showed fatty liver. Also
concerns re system infection (pos blood cultures). All organs declined.
13 Age, diabetic, bladder ca, MALT lymphoma (radiotherapy) previous heavy drinker.
14Extensive medical hx MGUS, AAA, abdo surgery, cardiac hx. Tried to source reports etc but declined due
to difficulty with donor surgery, risks, vasculopath. Nil organs retrieved.
15 Bowel resection, endoanal tumour, high risk of donor tumour.
16Age, Hx CVA, COPD, CKD, heavy smoker. Decline due to age, hx and risk of calcified vessels, no pts sick
enough to risk.
17Ischaemic hepatitis in an elderly patient/AST > 750 ALT > 750 not medically suitable. Not yet BD at
enquiry.
18 40 yr hx type 1 diabetes, HT, high chol and 87 years. Also risk of fatty liver.
19 DCD, kidneys rejected, ETOH, heavy smoker, recent large weight loss.
© copyright ANLTU Data to 31 December 2016
Enquiries Declined 2016
** Other 1 Did not proceed to offer. HCV pos donor. We were interested however NZ accepted.
2 No diagnosis, too many unknowns in a 10 month microcephalic paediatric donor.
3 Anencephalic 36 week old foetus to be DCD. Donor too small and situation too complicated.
4No patients sick enough to justify high risk. HCV, LT IVDU, ETOH binge, prison, tattoo, recent
sexual assault, high inotropes.
5Did not proceed to formal offer. Were awaiting BD confirmation but pt died suddenly. Significant
cardiac and renal hx. Would have been liver only donor.
6Did not progress to formal offer/BD. Hx dementia, malnutrition, pacemaker, COPD, CAGS,
ureteric stent.
7Did not proceed to formal offer. We did not exclude this offer and would consider if progressed
to formal EDR. Did not progress to BD.
8Did not proceed as a donor. We were interested if they thought BD but deemed would probably
not progress and treatment withdrawn.
9 DCD with > 1hr downtime. Became kidney and heart valve donor.
10Enquiry for HCV treated potential donor, did not progress to BD. Proceeded to DCD for kidney
and lung.
Data to 31 December 2016 © copyright ANLTU 13
DBD Donor Offers
© copyright ANLTU Data to 31 December 2016
47 48
6062
6468
66
83
103
119
12 11
20
25
1618 18
30
2325 26
23
28
20
40
46
0
20
40
60
80
100
2008 2009 2010 2011 2012 2013 2014 2015 2016
Used Declined at Hepatectomy Declined at Offer
DBD Donor Offers to NSW
DCD Donor Offers
© copyright ANLTU Data to 31 December 2016
2
4
8
5
2
3
5
8
2
6
8
10
5
9
7
8
13
9
8
11
18
9
15
7
6
5
15
0
2
4
6
8
10
12
14
16
18
20
2008 2009 2010 2011 2012 2013 2014 2015 2016
Used Declined at Hepatectomy Declined at Offer
DCD Donor Offers to NSW
Data to 31 December 2016 © copyright ANLTU 14
Allocation of Accepted and Utilised Deceased Donor Offer Livers 2016
© copyright ANLTU Data to 31 December 2016
Allocation of Accepted and Utilised Deceased Donor Livers
1st Recipient Allocation Total
DBD
Highest prioritised patient suitable for this type of graft 86
Size of graft not suitable for higher priority patient(s) 11
Higher priority patient(s) medically unfit 1
Higher priority patient(s) has HCV and older donor
Logistical reasons not suitable for higher priority patients 1
Positive donor virology 1
Other * 3
DCD Highest prioritised patient suitable for this type of graft 2
Total 105
2nd Recipient Allocation
DBD
Highest prioritised patient suitable for this type of graft 6
Higher priority patient(s) medically unfit 1
Size of graft not suitable for higher priority patient(s) 1
Total 8
* Other 1 Good size match for paed recipient's 3rd transplant
2 Initially accepted by QLD on rotation was waived to NSW for Cat 2a
3 Liver/lung - suitable match for lungs
Living Donor Procedures – Paediatric & Adult
© copyright ANLTU Data to 31 December 2016
Living Donor Procedures – Paediatric and Adult
* The Living Unrelated Donor Procedures in 2003 and 2013 were adult domino transplants.
** The Living Unrelated Donor Procedure in 2011 was adult to adult.
Year 1990 2002 2003 2004 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Total
TypeLRD LRD LUD
*
LRD LRD LRD LRD LRD LRD LUD
**
LRD LUD
*
LRD LRD
Total 1 1 1 1 2 3 3 2 3 1 2 1 0 1 2 24
Data to 31 December 2016 © copyright ANLTU 15
Deceased Donor Age by Era (Median)
© copyright ANLTU Data to 31 December 2016
020
4060
80D
onor
Age
- Y
ears
1986 - 1996 1997 - 2006 2007 - 2016
Deceased Donor Age by Era
n 382 525 744
Median 30 42 45
Mean 31.7 39.3 43.1
n = 1651
Median 40 years
Mean 39.2 years
Range 0.01 – 87 years
The donor age ranged from 0 to 87 years, with a mean value of 40 years.
Donors over 50 years
© copyright ANLTU Data to 31 December 2016
1 2 1 1
58
10
3 4 57
9 96
8
47
18
118 8
14
9 1012
17
10
1517
28
1
4
3
1
3 1
3
86
32
4
4
6
8
5 5
7
9 7
13
13
11
9
14
11
2
22
3
5
2
5
1
2
6
4
3
7
8
7
6
1
1
21
3
1
0
5
10
15
20
25
30
35
40
45
50
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
2013
2014
2015
2016
> 80 (n = 9)
71 - 80 (n = 65)
61 - 70 (n = 161)
51 - 60 (n = 267)
Deceased Donors Over 50 Years(n = 502)
Data to 31 December 2016 © copyright ANLTU 16
Deceased Donor Cause of Death
© copyright ANLTU Data to 31 December 2016
Hypoxia/Anoxia16%
Cerebrovascular Accident
48%
Tumour1%
Road Trauma21%
Other Trauma11%
Other2% Suicide
1%
Hypoxia/AnoxiaCerebrovascular AccidentTumourRoad TraumaOther TraumaOtherSuicide
Deceased Donor Cause of Death(n = 1651)
799 (48%) donors died due to cerebral haemorrhage, 525 (33%) died due to trauma.
© copyright ANLTU Data to 31 December 2016
35
50
174
167
294
338
7
3
7
126
122
103
43
45
86
3
3
6
1
8
30
0 50 100 150 200 250 300 350 400
1986 - 1996
1997 - 2006
2007 - 2016
OtherSuicideOther TraumaRoad TraumaTumourCerebrovascular AccidentHypoxia/Anoxia
Deceased Donor Cause of Death by Era
Deaths due to trauma were 44% (1986 – 1996), 32% (1997 – 2006) and 25% (2007 – 2016). In
these same time periods, deaths due to cerebral causes were 44%, 56% and 45%.
Data to 31 December 2016 © copyright ANLTU 17
© copyright ANLTU Data to 31 December 2016
7
2321
33
46
40
48
40
53
59
20
17
1315
1112 12
21
1817
23
6
10
56
3 32
3
6
2
7
21 1 1
0
5
10
15
20
25
30
35
40
45
50
55
60
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
S0 (n = 370)
S1 (n = 156)
S2 (n = 43)
S3 (n = 20)
Adult Graft Steatosis 2007 - 2016
Steatosis Scoring:
S0 less than 5% steatosis in biopsy (either macro or micro)
S1 Ma/Mi 5 – 29% Macrovesicular steatosis on biopsy combined with varying degrees of Micro
S2 Ma/Mi 30 < 60% Macrovesicular steatosis on biopsy combined with varying degrees of Micro
S3 Ma/Mi 60 +% Macrovesicular steatosis on biopsy combined with varying degrees of Micro
Since 2007 there are 19 cases (3.1%) where post reperfusion biopsy was not performed.
Data to 31 December 2016 © copyright ANLTU 18
RECIPIENT DEMOGRAPHICS
Data to 31 December 2016 © copyright ANLTU 19
Patient Age at Transplant
© copyright ANLTU Data to 31 December 2016
86 75
119
220
304
526
164
48
-50
50
150
250
350
450
550
< 1 1 - 3 4 - 15 16 - 40 41 - 50 51 - 60 61 - 65 > 65
Breakdown of Patient Age at Primary Transplant(n = 1542)
The modal group was in the age range 51 – 60 years (34.1%).
Primary Hepatic Disease
© copyright ANLTU Data to 31 December 2016
Biliary Atresia11%
Malignancy9%
HCV19%
Metabolic9%
Fulminant10%
ALD10%
CC2%
PSC8%
PBC5%
Other4%
AIH4%
HBV5%
B,C1%
NASH/NAFLD3%
Primary Disease – All Patients(n = 1542)
The most common primary indications for transplantation are Chronic Hepatitis C (292, 19%),
Biliary Atresia (165, 11%), Alcoholic Disease (158, 10%) and Fulminant Liver Failure (150, 10%).
Data to 31 December 2016 © copyright ANLTU 20
© copyright ANLTU Data to 31 December 2016
Biliary Atresia1%
Malignancy11%
HCV23%
Metabolic6%
Fulminant9%
ALD13%
CC2%
PSC10%
PBC6%
Other4%
AIH4%
HBV7%
B,C1% NASH/NAFLD
3%
Primary Disease – Adults(n = 1256)
Hepatitis C was the most common indication of transplantation in adults (292, 23%), followed by
Alcoholic Liver Disease (ALD 158, 13%), Malignancy (137, 11%), Primary Sclerosing Cholangitis (PSC
126, 10%), Fulminant Hepatic Failure (119, 19%), and Hepatitis B (83, 7%).
© copyright ANLTU Data to 31 December 2016
Biliary Atresia54%
Malignancy3%
Metabolic21%
Fulminant11%
CC1% Other
8%AIH2%
Primary Disease – Children(n = 286)
The most common indication for transplantation in children was Biliary Atresia (154, 54%),
followed by Metabolic disease (62, 21%) and Fulminant Hepatic Failure (31, 11%).
Data to 31 December 2016 © copyright ANLTU 21
Chronic Viral and Auto-Immune Hepatitis
© copyright ANLTU Data to 31 December 2016
Chronic Viral and Auto-Immune HepatitisPrimary and Secondary
n = 581 (46.3% of all Adults)
AIH9% B, C
2%
HCV64%
HBV22%
HDV3%
Viral91%
Auto-Immune Hepatitis (AIH) comprised 9% of cases, the remainder (91%) being viral in origin
(CVH). Of the cases of viral hepatitis, the most common is Hepatitis C (HCV, 64%), followed by
Hepatitis B (HBV, 22%) HDV (3%) and HBV/HCV co-infection (2%).
© copyright ANLTU Data to 31 December 2016
Chronic Viral (Primary and Secondary)Adults by Era
13%12%
75%
1986 - 1996
8%
39%53%
2007 - 2016
HBV (n = 129)
HCV (n = 372)
Non Viral (n = 755)
12%
31%57%
1997 - 2006
The number of patients requiring transplantation due to HCV has steadily increased over the three
time periods, whereas the number of patients requiring transplantation for HBV has now
decreased.
Data to 31 December 2016 © copyright ANLTU 22
© copyright ANLTU Data to 31 December 2016
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1986 - 1996 1997 - 2006 2007 - 2014 2015 2016
Non Viral (n = 755) HBV (n = 129) HCV (n = 372)
% Adults with Chronic HBV or HCV(Primary and Secondary)
Chronic HCV infection comprises 29.6% of adults transplanted.
Fulminant Hepatic Failure as Primary Indication Treated by Liver Transplantation
© copyright ANLTU Data to 31 December 2016
Fulminant Hepatic Failure As Primary Indication Treated by Liver Transplantation
Aetiology No of Patients No of TxOutcome
Alive Dead
Idiopathic 53 58 34 19
Drug Induced 25 27 16 9
Wilson’s Disease 14 16 12 2
Viral Hepatitis
Hep B 33 35 20 13
Hep C 1 1 1 0
Hep A 3 3 0 3
Hep E 1 1 0 1
Autoimmune Hepatitis 6 7 4 2
Budd-Chiari 1 1 0 1
Other 13 15 9 4
Totals 150 164 96 (64% pts) 54 (36% pts)
Data to 31 December 2016 © copyright ANLTU 23
HCC and Associated Disease
© copyright ANLTU Data to 31 December 2016
HCC and Associated DiseaseAdults by Era
HCC Only10%
HBV40%
HCV*30%
Other20%
1986 - 1996
* HCV includes 1 case of HBV,HCV
NASH/NAFLD
7%
HBV25%
HCV *50%
Alcoholic Cirrhosis
14%
Other8%
1997 - 2006
* HCV includes 3 cases of HBV,HCV
© copyright ANLTU Data to 31 December 2016
HCC and Associated DiseaseAdults by Era
HCC Only1%
NASH/NAFLD
6%
HBV *16%
HCV48%
Alcoholic Cirrhosis
22%
Other8%
2007 - 2011
* HBV includes 1 case of HDV
NASH/NAFLD
11%
HBV *13%
HCV **43%
Alcholic Cirrhosis
27%
Other6%
2012 - 2016
* HBV includes 2 cases of HDV** HCV includes 2 cases of HBV,HCV
Data to 31 December 2016 © copyright ANLTU 24
NASH/NAFLD by Era
© copyright ANLTU Data to 31 December 2016
NASH/NAFLD (Primary and Secondary)Adults by Era
NASH/NAFLD
2%
Other98%
1997 - 2006
NASH/NAFLD
0%
Other100%
1986 - 1996
© copyright ANLTU Data to 31 December 2016
NASH/NAFLD (Primary and Secondary)Adults by Era
NASH/NAFLD
5%
Other94%
2007 - 2011
NASH/NAFLD
10%
Other86%
2012 - 2016
Data to 31 December 2016 © copyright ANLTU 25
Indication For Secondary Transplantation
© copyright ANLTU Data to 31 December 2016
2
913
47
21
5
4
6
6
11
16
31
2
7 81
5
5
13
11 1
4
3
0
5
10
15
20
25
30
35
40
0 - 7 days 8 - 30 days 1 - 6 months 6 months - 1 year
1 - 5 years > 5 years
Time to Secondary Transplant
Other
Biliary Strictures
Viral Recurrence
PNF
Rejection
Vascular
Indication for Secondary Transplantation(n = 141)
Primary non function (PNF) is the major indication for re-transplantation in the first 7 days.
Rejection and vascular indications are prominent indications for re-transplantation in all other
time periods.
© copyright ANLTU Data to 31 December 2016
50.0%
54.3%
47.1%49.1%
67.9%
51.7% 52.4%
0%
10%
20%
30%
40%
50%
60%
70%
1986 - 1990 1991 - 1995 1996 - 2000 2001 - 2005 2006 - 2010 2011 - 2015 2016
Percentage of Children Transplanted for Biliary Atr esia(n = 154; 53.8% of all Children)
Data to 31 December 2016 © copyright ANLTU 26
PERIOPERATIVE DATA
Data to 31 December 2016 © copyright ANLTU 27
Mean/Median Hospital Stay
© copyright ANLTU Data to 31 December 2016
9
5 56
5
34
3 3
5 5
23 3 3
7
2 3 3 4
6
43 3
7 6 75
6 68
36
32
44
49
42
32
38
24 24
40
26
32
42
25 2526
24
21
18
23
20
15
1918
1719
18
14
17
12
16
0
5
10
15
20
25
30
35
40
45
50
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
2013
2014
2015
2016
ICU (Mean)
Ward (Mean)
ICU (Median)
Ward (Median)
Hospital Stay (Mean & Median Days)Adults Only
Red Cell Usage
© copyright ANLTU Data to 31 December 2016
133 133
58
1610
4
0
20
40
60
80
100
120
140
1986 - 1996 1997 - 2006 2007 - 2016
Red Cell Usage (Max)
Red Cell Usage (Median)
Red Cell Usage(Units of Packed Cells)
Graft Ischaemic Time, Operation Duration and Red Cell Utilisation
© copyright ANLTU Data to 31 December 2016
Graft Ischaemic Time, Operation DurationAnd Red Cell Utilisation
1986 – 1996 1997 – 2006 2007 – 2016
Mean Graft Ischaemic Time 9 hr 20 min 9 hr 12 min 8 hr 03 min
Mean Operation Time 7 hr 45 min 7 hr 15 min 7 hr 16 min
Mean Cold Ischaemic Time 9 hr 21 min 8 hr 18 min 7 hr 13 min
No. Of Packed Cells Utilised1 – 133
Mean = 21.7;
Median = 16
0 – 133
Mean = 14.0;
Median = 11
0 – 58
Mean = 6.3;
Median = 4
Data to 31 December 2016 © copyright ANLTU 28
OUTCOME DATA
Data to 31 December 2016 © copyright ANLTU 29
Patient Survival
© copyright ANLTU Data to 31 December 2016
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ving
0 5 10 15 20 25 30Years Post Transplant
Overall Patient Survival 1986 - 2016Adults and Children
1yr 5yr 10yr 15yr 20yr 25yr 30yr
No at risk 1270 874 562 311 156 62 3
Actuarial Survival % 88 79 70 62 53 44 41
n = 1542
© copyright ANLTU Data to 31 December 2016
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0 6 1812 24Months Post Transplant
Patient Survival 2015 - 2016Adults and Children
n = 191
6m 12m 18m
No at risk 135 89 43
Actuarial Survival % 95 93 92
Data to 31 December 2016 © copyright ANLTU 30
© copyright ANLTU Data to 31 December 2016
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ving
0 5 10 15 20 25Years Post Transplant
Patient Survival 1986 – 2016Adults vs Children
1yr 5yr 10yr 15yr 20yr 25yr 30yr
ChildNo at risk 235 179 126 76 44 24 2
Actuarial Survival % 89 87 84 81 77 66 66
Adult No at risk 1035 695 436 235 112 38 1
Actuarial Survival % 88 77 67 58 46 39 38
Child (n = 286)
Adult (n = 1256)
p < .01
© copyright ANLTU Data to 31 December 2016
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ving
0 6 1812 24Months Post Transplant
Patient Survival 2015 - 2016Adults vs Children
Child (n = 39)
Adult (n = 152)
p = ns
6m 12m 18m
ChildNo at risk 25 20 10
Actuarial Survival % 94 94 94
Adult No at risk 110 72 33
Actuarial Survival % 96 94 92
Data to 31 December 2016 © copyright ANLTU 31
Children
© copyright ANLTU Data to 31 December 2016
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ving
0 5 10 15 20 25 30Years Post Transplant
Children – Weight vs OutcomePrimary Grafts
<10kg (n = 126)
>10kg (n = 16)
p = ns
1yr 5yr 10yr 15yr 20yr 25yr 30yr
<10kgNo at risk 100 74 45 23 13 6 2
Actuarial Survival % 84 83 81 80 80 80 80
>10kgNo at risk 135 105 81 53 31 18
Actuarial Survival % 92 90 86 83 77 63
© copyright ANLTU Data to 31 December 2016
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ving
0 5 10 15 20 25 30Years Post Transplant
Children – Type of Transplant vs OutcomePrimary Grafts
Split (n = 116)
Whole (n = 77)
Reduced (n = 93)
p < .01
1yr 5yr 10yr 15yr 20yr 25yr 30yr
SplitNo at risk 97 60 31
Actuarial Survival % 94 92 91
WholeNo at risk 66 55 48 38 20 8 1
Actuarial Survival % 95 95 93 89 85 68 68
ReducedNo at risk 72 64 49 38 24 16 1
Actuarial Survival % 78 74 71 68 64 58 58
Data to 31 December 2016 © copyright ANLTU 32
© copyright ANLTU Data to 31 December 2016
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ving
0 5 10 15 20 25 30Years Post Transplant
Children – Donor TypePrimary Grafts
Split (n = 114)
Whole (n = 77)
Live (n = 16)
Reduced (n = 79)
p < .01
1yr 5yr 10yr 15yr 20yr 25yr 30yr
SplitNo at risk 96 59 30
Actuarial Survival % 94 92 91
WholeNo at risk 66 55 48 38 20 8 1
Actuarial Survival % 95 95 93 89 85 68 68
LiveNo at risk 12 3
Actuarial Survival % 81 81
ReducedNo at risk 61 54 47 38 24 16 1
Actuarial Survival % 78 73 70 67 63 57 57
© copyright ANLTU Data to 31 December 2016
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ving
0 5 10 15 20 25 30Years Post Transplant
Fulminant Disease vs OutcomeAdults vs Children
Child (n = 31)
Adult (n = 119)
p = ns
1yr 5yr 10yr 15yr 20yr 25yr
ChildNo at risk 26 20 15 8 6 3
Actuarial Survival % 87 87 82 82 68 21
Adult No at risk 86 67 45 27 15 6
Actuarial Survival % 76 71 65 59 48 40
Data to 31 December 2016 © copyright ANLTU 33
Primary Disease and Outcome
© copyright ANLTU Data to 31 December 2016
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0 5 10 15 20 25 30Years Post Transplant
Primary Disease vs OutcomeAdults
Malignancy (n = 137)
Metabolic (n = 77)
PBC (n = 74)
PSC (n = 126)
Alcoholic (n = 158)
CC (n = 29)
p < . 01
© copyright ANLTU Data to 31 December 2016
025
5075
100
% S
urvi
ving
0 5 10 15 20 25 30Years Post Transplant
Primary Disease vs OutcomeChildren
CC (n = ?)
BA (n = 154)
CAH (n = 5)
FHF (n = 31)
Metabolic (n = 62)
Malignancy (n = 9)
p = ns
Data to 31 December 2016 © copyright ANLTU 34
Status at Transplant vs Patient Outcome
© copyright ANLTU Data to 31 December 2016
025
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% S
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ving
0 5 10 15 20 25 30Years Post Transplant
Status vs OutcomeAdults and Children – Primary Grafts
At home (n = 690)
ICU (n = 149)
Hosp.
Bound(n = 267)
Oc.
Inpatient(n = 436)
p < .01
© copyright ANLTU Data to 31 December 2016
Status vs OutcomeAdults and Children – Primary Grafts
1yr 5yr 10yr 15yr 20yr 25yr 30yr
At Home
(n = 690)
No at risk 595 396 253 124 52 25 2
Actuarial Survival % 93 83 75 66 59 50 50
ICU
(n = 149)
No at risk 110 76 51 30 21 9
Actuarial Survival % 77 70 66 60 55 50
Hos. Bound
(n = 267)
No at risk 202 129 69 44 25 10 1
Actuarial Survival % 85 76 67 61 49 37 37
Oc. Inpatient
(n = 436)
No at risk 363 273 189 113 61 20
Actuarial Survival % 86 77 66 58 47 39
Data to 31 December 2016 © copyright ANLTU 35
© copyright ANLTU Data to 31 December 2016
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ving
0 5 10 15 20 25 30Years Post Transplant
Chronic Viral, Autoimmune Disease vs OutcomePrimary Grafts
HBV (n = 83)
AI (n = 56)
HCV (n = 292)
B, C (n = 9)
p = ns
© copyright ANLTU Data to 31 December 2016
Chronic Viral, Autoimmune Disease vs OutcomePrimary Grafts
1yr 5yr 10yr 15yr 20yr 25yr
HBV
(n = 83)
No at risk 67 48 40 28 13 4
Actuarial Survival % 81 71 68 54 50 50
AI
(n = 56)
No at risk 50 37 28 20 17 6
Actuarial Survival % 91 81 71 60 57 48
HCV
(n = 292)
No at risk 241 145 75 31 7 3
Actuarial Survival % 89 75 62 53 35 35
B, C
(n = 9)
No at risk 9 9 9 7 3
Actuarial Survival % 100 100 100 100 67
Data to 31 December 2016 © copyright ANLTU 36
Chronic HBV Outcomes
© copyright ANLTU Data to 31 December 2016
025
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ving
0 5 10 15 20 25 30Years Post Transplant
Chronic HBV Before and After Prophylaxis Protocol*Primary and Secondary Indication
* Oral nucleos(t)ide therapy + low dose monthly IMI HBIG
Post
23/2/1996(n = 110)
Pre
23/2/1996(n = 32)
p = ns
1yr 5yr 10yr 15yr 20yr 25yr
Post
23/2/1996
No at risk 98 65 45 25 3
Actuarial Survival % 91 81 78 66 61
Pre
23/2/1996
No at risk 23 20 19 17 15 4
Actuarial Survival % 72 60 56 17 47 37
© copyright ANLTU Data to 31 December 2016
025
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ving
0 5 10 15 20 25Years Post Transplant
Chronic HBV (Primary and Secondary) vs Era
2007 – 2016 (n = 48)
1997 – 2006 (n = 56)
1986 – 1996 (n = 38)
p = ns
1yr 5yr 10yr 15yr 20yr 25yr
2007 - 2016No at risk 43 17
Actuarial Survival % 94 84
1997 - 2006No at risk 49 45 42 22
Actuarial Survival % 88 79 75 64
1986 - 1996No at risk 29 24 22 20 18 4
Actuarial Survival % 76 61 58 50 47 38
Data to 31 December 2016 © copyright ANLTU 37
Chronic HCV Outcomes
© copyright ANLTU Data to 31 December 2016
025
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urvi
ving
0 5 10 15 20 25 30Years Post Transplant
Chronic HCV (Primary and Secondary) vs Era
2007 – 2016 (n = 220)
1997 – 2006 (n = 133)
1986 – 1996 (n = 35)
p = ns
1yr 5yr 10yr 15yr 20yr 25yr
2007 - 2016No at risk 177 72
Actuarial Survival % 92 75
1997 - 2006No at risk 119 99 83 24
Actuarial Survival % 89 74 62 56
1986 - 1996No at risk 35 29 23 18 13 3
Actuarial Survival % 100 80 60 51 37 27
© copyright ANLTU Data to 31 December 2016
025
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ving
0 5 10 15 20 25 30Years Post Transplant
Chronic HCV Primary vs Secondary IndicationPrimary Graft Survival
Secondary (n = 84)
Primary (n = 301)
p = ns
1yr 5yr 10yr 15yr 20yr 25yr
SecondaryNo at risk 73 45 20 9 4 1
Actuarial Survival % 91 73 60 54 54 54
PrimaryNo at risk 250 154 84 36 10 3
Actuarial Survival % 90 76 63 50 35 19
Data to 31 December 2016 © copyright ANLTU 38
© copyright ANLTU Data to 31 December 2016
025
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urvi
ving
0 5 10 15 20 25 30Years Post Transplant
HCV vs Donor Age vs Primary Graft OutcomeAdults (n = 388)
> 60 (n = 62)
<30 (n = 92)
30 - 50 (n = 149)
50 - 60 (n = 85)
p = ns
© copyright ANLTU Data to 31 December 2016
HCV vs Donor Age vs Primary Graft OutcomeAdults (n = 388)
1yr 5yr 10yr 15yr 20yr 25yr
>60
(n = 62)
No at risk 47 26 14 4 2
Actuarial Survival % 86 69 47 47 47
<30
(n = 92)
No at risk 78 51 35 18 5 4
Actuarial Survival % 89 75 70 63 40 40
30 - 50
(n = 149)
No at risk 121 76 38 14 4 1
Actuarial Survival % 87 73 58 49 46 23
50 - 60
(n = 85)
No at risk 71 36 14 4 3
Actuarial Survival % 89 69 54 46 34
Data to 31 December 2016 © copyright ANLTU 39
© copyright ANLTU Data to 31 December 2016
025
5075
100
% S
urvi
ving
0 5 10 15 20 25 30Years Post Transplant
Non HCV vs Donor Age vs Primary Graft OutcomeAdults (n = 868)
> 60 (n = 181)
< 30 (n = 247)
30 - 50 (n = 281)
50 - 60 (n = 159)
p = ns
© copyright ANLTU Data to 31 December 2016
Non HCV vs Donor Age vs Primary Graft OutcomeAdults (n = 868)
1yr 5yr 10yr 15yr 20yr 25yr 30yr
>60
(n = 181)
No at risk 143 77 32 14 4 2
Actuarial Survival % 84 77 62 49 49 49
<30
(n = 247)
No at risk 194 159 115 83 45 19 1
Actuarial Survival % 80 73 65 60 514 44 41
30 - 50
(n = 281)
No at risk 230 162 111 59 30 11
Actuarial Survival % 86 75 66 55 42 34
50 - 60
(n = 159)
No at risk 119 77 54 27 16 2
Actuarial Survival % 84 69 60 50 37 24
Data to 31 December 2016 © copyright ANLTU 40
Donor Age vs Primary Graft Outcome
© copyright ANLTU Data to 31 December 2016
025
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% S
urvi
ving
0 5 10 15 20 25 30Years Post Transplant
Donor Age vs Primary Graft Outcome
> 80 (n = 9)
61 - 70 (n = 151)
< 30 (n = 547)
71 – 80 (n = 61)
31 – 50 (n = 521)
51 – 60 (n = 253)
p = ns
© copyright ANLTU Data to 31 December 2016
Donor Age vs Primary Graft Outcome
1yr 5yr 10yr 15yr 20yr 25yr 30yr
> 80
(n = 9)
No at risk 8 2
Actuarial Survival % 100 100
61 – 70
(n = 151)
No at risk 119 68 30 13 7 3
Actuarial Survival % 84 74 62 51 51 51
< 30
(n = 547)
No at risk 431 322 230 154 80 36 2
Actuarial Survival % 83 76 69 64 55 47 46
71 - 80
(n = 61)
No at risk 48 23 10 5
Actuarial Survival % 85 75 50 44
31 - 50
(n = 521)
No at risk 423 291 182 88 41 14 1
Actuarial Survival % 86 74 64 54 42 33 33
51 - 60
(n = 253)
No at risk 195 120 63 32 15 3
Actuarial Survival % 85 71 59 54 41 29
Data to 31 December 2016 © copyright ANLTU 41
Steatosis vs Graft Outcome (Adults)
© copyright ANLTU Data to 31 December 2016
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ving
0 5 10 15Years Post Transplant
Macro Steatosis vs Primary Graft Outcome (Adults)2001 - 2016
S1 Ma/Mi (n = 74)
S2 Ma/Mi (n = 22)
S0 (n = 434)
S3 Ma/Mi (n = 6)
p = ns
1yr 5yr 10yr 15yr
S1 Ma/MiNo at risk 54 20
Actuarial Survival % 84 77
S2 Ma/MiNo at risk 22 10
Actuarial Survival % 77 63
S0No at risk 340 146 42 6
Actuarial Survival % 90 76 65 55
S3 Ma/MiNo at risk 6 2
Actuarial Survival % 50 50
© copyright ANLTU Data to 31 December 2016
025
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% S
urvi
ving
0 5 10 15Years Post Transplant
Micro Steatosis vs Primary Graft Outcome (Adults)2001 - 2016
S3 Mi (n = 30)
S1 Mi (n = 94)
S2 Mi (n = 29)
S0 (n = 434)
p = ns
1yr 5yr 10yr 15yr
S3 MiNo at risk 30 26 14 4
Actuarial Survival % 100 87 76 76
S1 MiNo at risk 82 66 35 1
Actuarial Survival % 91 83 67 65
S2 MiNo at risk 23 22 13 1
Actuarial Survival % 82 72 67 61
S0No at risk 340 146 42 6
Actuarial Survival % 90 76 65 55
Data to 31 December 2016 © copyright ANLTU 42
Graft Survival
© copyright ANLTU Data to 31 December 2016
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ving
0 5 10 15 20 25 30Years Post Transplant
Graft Survival by Graft NoAdults and Children
Tertiary (n = 16)
Primary (n = 1542)
Secondary (n = 117)
p < .01
© copyright ANLTU Data to 31 December 2016
Graft Survival by Graft NoAdults and Children
1yr 5yr 10yr 15yr 20yr 25yr 30yr
Tertiary
(n = 16)
No at risk 10 10 3 2 2
Actuarial Survival % 68 68 68 68 68
Primary
(n = 1542)
No at risk 1224 826 515 290 140 56 3
Actuarial Survival % 84 74 65 58 48 40 39
Secondary
(n = 117)
No at risk 70 46 26 14 7 4
Actuarial Survival % 69 58 43 39 27 27
Data to 31 December 2016 © copyright ANLTU 43
© copyright ANLTU Data to 31 December 2016
025
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% S
urvi
ving
0 6 1812 24Months Post Transplant
Graft Survival by Graft NoAdults and Children 2015 – 2016
Tertiary (n = 2)
Secondary (n = 18)
Primary (n = 191)
p = ns
6m 12m 18m
TertiaryNo at risk 2 2 1
Actuarial Survival % 100 100 100
SecondaryNo at risk 10 4
Actuarial Survival % 94 94
PrimaryNo at risk 131 87 42
Actuarial Survival % 92 88 87
© copyright ANLTU Data to 31 December 2016
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% S
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ving
0 6 1812 24Months Post Transplant
Graft SurvivalAdults vs Children 2015 - 2016
Adult (n = 164)
Child (n = 47)
p = ns
6m 12m 18m
AdultNo at risk 114 74 33
Actuarial Survival % 93 89 87
ChildNo at risk 29 19 10
Actuarial Survival % 89 85 85
Data to 31 December 2016 © copyright ANLTU 44
© copyright ANLTU Data to 31 December 2016
025
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% S
urvi
ving
0 5 10 15 20 25 30Years Post Transplant
Primary Graft Survival by EraAdults and Children
2007 – 2016 (n = 700)
1997 – 2006 (n = 493)
1986 - 1996 (n = 349)
p < .01
1yr 5yr 10yr 15yr 20yr 25yr 30yr
2007 - 2016No at risk 548 227
Actuarial Survival % 90 77
1997 - 2006No at risk 424 377 328 122
Actuarial Survival % 86 76 67 59
1986 - 1996No at risk 252 222 187 168 140 56 3
Actuarial Survival % 72 64 54 48 40 33 32
© copyright ANLTU Data to 31 December 2016
025
5075
100
% S
urvi
ving
0 5 10 15 20 25 30Years Post Transplant
Primary Graft Survival by EraAdults
2007 – 2016 (n = 574)
1997 – 2006 (n = 402)
1986 – 1996 (n = 280)
p < .01
1yr 5yr 10yr 15yr 20yr 25yr 30yr
2007 - 2016No at risk 454 184
Actuarial Survival % 90 75
1997 - 2006No at risk 344 302 261 96
Actuarial Survival % 86 75 65 57
1986 - 1996No at risk 205 178 145 127 102 35 1
Actuarial Survival % 73 64 52 45 36 29 28
Data to 31 December 2016 © copyright ANLTU 45
© copyright ANLTU Data to 31 December 2016
025
5075
100
% S
urvi
ving
0 5 10 15 20 25 30Years Post Transplant
Primary Graft Survival by EraChildren
2007 – 2016 (n = 126)
1997 – 2006 (n = 91)
1986 – 1996 (n = 69)
p < .01
1yr 5yr 10yr 15yr 20yr 25yr 30yr
2007 - 2016No at risk 94 43
Actuarial Survival % 88 85
1997 - 2006No at risk 80 76 67 26
Actuarial Survival % 88 82 74 72
1986 - 1996No at risk 47 45 44 42 38 21 2
Actuarial Survival % 68 34 31 59 55 48 48
Split vs Reduced vs Whole Grafts
© copyright ANLTU Data to 31 December 2016
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ving
0 5 10 15Years Post Transplant
Split vs Whole Grafts (Adults)Primary Graft Survival 2002 – 2016
Split (n = 122)
Whole (n = 673)
p = ns
1yr 5yr 10yr
SplitNo at risk 99 57 28
Actuarial Survival % 87 77 69
WholeNo at risk 550 300 120
Actuarial Survival % 90 77 67
Data to 31 December 2016 © copyright ANLTU 46
© copyright ANLTU Data to 31 December 2016
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ving
0 5 10 15Years Post Transplant
Split vs Reduced vs Whole Grafts (Children)Primary Graft Survival 2002 – 2016
Whole (n = 32)
Reduced (n = 32)
Split (n = 115)
p = ns
1yr 5yr 10yr
WholeNo at risk 23 13 8
Actuarial Survival % 93 93 93
ReducedNo at risk 27 23 8
Actuarial Survival % 87 87 79
SplitNo at risk 92 53 25
Actuarial Survival % 88 84 73
© copyright ANLTU Data to 31 December 2016
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ving
0 2 4 6 8 10Years Post Transplant
Split vs Reduced vs Whole Grafts (Children)Patient Survival 2002 – 2016
Whole (n = 32)
Split (n = 115)
Reduced (n = 32)
p = ns
1yr 5yr 10yr
WholeNo at risk 25 14 8
Actuarial Survival % 100 100 100
SplitNo at risk 97 60 31
Actuarial Survival % 95 93 91
ReducedNo at risk 27 23 10
Actuarial Survival % 87 87 87
Data to 31 December 2016 © copyright ANLTU 47
Auxiliary Transplant Survival
© copyright ANLTU Data to 31 December 2016
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0 2 4 6 8 10 12 14Years Post Transplant
Auxiliary Transplant (Children)Patient and Graft Survival
Graft
Survival(n = 3)
Patient
Survival(n = 3)
p = ns
1yr 5yr 10yr
GraftNo at risk 3 1 1
Actuarial Survival % 67 67 67
PatientNo at risk 2 1 1
Actuarial Survival % 50 50 50
Data to 31 December 2016 © copyright ANLTU 48
Cause of Death
Cause of Death
Graft Failure 130 (26.6%)
Rejection: Chronic 28
Rejection: Acute 10
Recurrent disease
Hepatitis C 40
Biliary Complications 10
Hepatitis B 11
Vascular 15
PNF 4
NASH 3
Other 9
Malignancy 95 (19.5%)
De Novo 61
Recurrent disease 33
Transferred from donor 1
Sepsis 89 (18.2%)
Cardiovascular 33 (6.8%)
Cerebral 33 (6.8%)
Respiratory 27 (5.5%)
Multi-organ Failure 12 (2.5%)
Operative 11 (2.3%)
Gastrointestinal 10 (2.0%)
Vascular 8 (1.6%)
Renal Failure 5 (1.0%)
GVHD 4 (0.8%)
Other 31 (6.3%)
TOTAL 488
(31.6% of all patients)
Data to 31 December 2016 © copyright ANLTU 49
© copyright ANLTU Data to 31 December 2016
Cause of Death(n = 488)
Operative2%
Sepsis18%
Cardiovascular7%
Cerebral7%
Malignancy - De Novo13%
Malignancy -Recurrent
7%
Respiratory5%
Rejection8%
GI2%
Miscellaneous12%
Recurrent Disease12%
Biliary Complications2% PNF
1%Vascular (pt)
3%
Other1%
Graft failure27%
488 patients, or 33.7% of all patients transplanted, have died. Of these, 89 (18%) have died due to
sepsis and 130 (27%) from graft failure.
Of the 130 cases of death due to graft failure, 38 (29%) patients lost grafts due to rejection, 58
(45%) from recurrent disease and 4 (3%) from primary non function (PNF).
© copyright ANLTU Data to 31 December 2016
Cause of Death(n = 488)
Operative3%
Sepsis18%
Cardiovas7%
Cerebral6%
Malignancy20%
Respiratory5%
GI2%
Misc12%
Graft Failure27%
Adults (n = 436)
Sepsis21%
Cardiovas2%
Cerebral15%
Malignancy12%
Respiratory10%
GI2%
Misc17%
Graft Failure21%
Children (n = 52)
The majority of adult deaths were due to Graft Failure (119 or 27%), Malignancy (89 or 20%) and
Sepsis (78 or 18%). The majority of child deaths were due to Graft Failure (11 or 21%), Sepsis (11
or 21%) and Cerebrovascular accident (8 or 15%).
Data to 31 December 2016 © copyright ANLTU 50
© copyright ANLTU Data to 31 December 2016
7 7 7 6 32
152
2
4
1
12
1
4
1
1
46
29
20
12
9 3
23
15
108
13
262
1
17
12
7
6 6
3
8
3
10
3
3
4 1
1
41
1114
4 4
4
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<1 year 1 - 5 years 5 - 10 years 10 - 15 years
15 - 20 years
>20 years
Sepsis
Respiratory
Operative
Miscellaneous
Recurrent Malignancy
De Novo Malignancy
Graft Failure
Gastrointestinal
Cerebral
Cardiovascular
Cause of Death by Time - Adults(n = 436; 37.0% of adults)
© copyright ANLTU Data to 31 December 2016
18
72
11
1
1
2
1
1
7
2
2
1
1
1
6 1
2
1
11
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<1 year 1 - 5 years 5 - 10 years 10 - 15 years
15 - 20 years
>20 years
Gastrointestinal
Sepsis
Respiratory
Miscellaneous
Recurrent Malignancy
De Novo Malignancy
Graft Failure
Cerebral
Cardiovascular
Cause of Death by Time - Children(n = 52; 19.6% of children)
Data to 31 December 2016 © copyright ANLTU 51
© copyright ANLTU Data to 31 December 2016
11 15 6
15 82
52 47
20
2022
15
109
13
18
18 1510
57
3728
13
6 3 24 4 1
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1986 - 1996 1997 - 2006 2007 - 2016
GI
Operative
Sepsis
Respiratory
Miscellaneous
Recurrent Malignancy
De Novo Malignancy
Graft Failure
Cerebral
Cardiovascular
Cause of Death by Transplant Era - Adults(n = 436; 37.0% of adults)
© copyright ANLTU Data to 31 December 2016
1
7
1
4
6 1
5
1
4
2
3
2
3
73
11
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1986 - 1996 1997 - 2006 2007 - 2016
GI
Sepsis
Respiratory
Miscellaneous
Recurrent Malignancy
De Novo Malignancy
Graft Failure
Cerebral
Cardiovascular
Cause of Death by Transplant Era - Children(n = 52; 19.6% of children)
Data to 31 December 2016 © copyright ANLTU 52
© copyright ANLTU Data to 31 December 2016
Cause of Death – HCV Recipients(n = 129)
Cardiovascular5%
Cerebrovascular1%
Gastrointestinal1%
Other Graft Failure5%
Malignancy - De Novo12%
Malignancy -Persistent
14%
Operative4%
Sepsis14% Respiratory
1%
Recurrent HCV30%
Other 13%
Data to 31 December 2016 © copyright ANLTU 53
Cause of Graft Failure
Cause of Graft Failure Rejection 74 (11.9%)
Acute 15
Chronic 52
ABO incompatibility 6
Subacute 1
Vascular complications 53 (8.5%)
Hepatic artery thrombosis 38
Portal vein thrombosis 6
Graft infarction 2
Dissection in donor 1
Donor graft damage 1
Graft compression 1
Hepatic vein stenosis 1
PVT/HAT 1
Rupture 1
Vena Cava obstruction 1
Recurrent disease 103 (16.6%)
Hep C 47
Malignancy 29
Hep B 14
PSC 6
NASH 3
Alcohol 1
Cryptogenic cirrhosis 1
Primary non function 23 (3.7%)
Graft infarction 8
Severe steatosis 2
Antibody mediated rejection 1
Arterial thrombosis 1
Blood loss 1
HA occlusion 1
Preservation injury 1
Profound hypotension 1
Vena 1
Other 6
Patient deaths 306 (49.3%)
Sepsis 80
Malignancy 65
Cerebral 33
Cardiovascular 27
Respiratory failure 26
Intraoperative 15
GI haemorrhage 8
GVHD 4
Pancreatitis 3
Other 45
Biliary complications 35 (5.6%)
Biliary strictures 24
Other 11
Other 27 (4.3%)
TOTAL 621 (37.1%) of all grafts
Data to 31 December 2016 © copyright ANLTU 54
© copyright ANLTU Data to 31 December 2016
Cause of Graft Failure(n = 621)
Rejection12%
PNF4%
Vascular9%
Recurrent Disease17%
Other4%
GVHD1%
Malignancy10%
Other8%
Cardiac4% Intraop
2%Respiratory4%
Cerebral5%
Sepsis13%
GI1%
Biliary6%
Pancreatitis0.5%
Other48%
621 of 1675 grafts (37.1%) have failed.
306 grafts (51%) were lost due to patient deaths, 103 (17%) due to disease recurrence and 74
(12%) due to rejection.
Sepsis was the most significant cause of patient death (80 patients), followed by malignancy (65
patients) and cerebral catastrophe (32 patients).
© copyright ANLTU Data to 31 December 2016
Cause of Graft Failure(n = 621)
Rejection10%
PNF3%
Patient Death53%
Vascular6%
Recurrent Disease
20%
Other 4%
Biliary4%
Adults (n = 518)
Rejection22%
PNF7%
Patient Death32%
Vascular18%
Other 7%
Biliary14%
Children (n = 103)
Patient death was the most significant cause of graft failure, followed by rejection.
Data to 31 December 2016 © copyright ANLTU 55
© copyright ANLTU Data to 31 December 2016
5 3 5 4 22
5 73
3
2
16
106
54
50
32 21
10
26 46
20
7
428
107
1
4
127
5 1 1
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<1 year 1 - 5 years 5 - 10 years 10 - 15 years
15 - 20 years
>20 years
Vascular
Rejection
Recurrent Disease
Pt Death
PNF
Other
Biliary
Cause of Graft Failure by Time - Adults(n = 518; 38.6% of adult grafts)
© copyright ANLTU Data to 31 December 2016
22
7 3
3
1
2
17
25
2
2
1
1
2
8
7
5 1
1
114 4
1
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<1 year 1 - 5 years 5 - 10 years 10 - 15 years
15 - 20 years
>20 years
Vascular
Rejection
Pt Death
PNF
Other
Biliary
Cause of Graft Failure by Time - Children(n = 103; 30.9% of child grafts)
Data to 31 December 2016 © copyright ANLTU 56
© copyright ANLTU Data to 31 December 2016
11 8 2
4 4 122 6
8
109105
59
37
42 24
3311 7
11 14 9
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1986 - 1996 1997 - 2006 2007 - 2016
Vascular
Rejection
Recurrent Disease
Pt Death
PNF
Other
Biliary
Cause of Graft Failure by Transplant Era - Adults(n = 518; 38.6% of adult grafts)
© copyright ANLTU Data to 31 December 2016
3
6 53
1
3
4
1
2
21
6
6
10
9
4
6
9
4
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1986 - 1996 1997 - 2006 2007 - 2016
Vascular
Rejection
Pt Death
PNF
Other
Biliary
Cause of Graft Failure by Transplant Era - Children(n = 103; 30.9% of child grafts)
Data to 31 December 2016 © copyright ANLTU 57
CANCER AND
TRANSPLANTATION
Data to 31 December 2016 © copyright ANLTU 58
Malignancy at Transplantation
© copyright ANLTU Data to 31 December 2016
1 2 1 1 2 13
7
119
11
7 79
1514
11
18
12
18
15
25
19 20
2322
26
1
1
11 2 1
1
1
11
1 2
1
1 2
2
2
1
3
1
1
1
1
1
1
2
2
1
1
0
5
10
15
20
25
3019
87
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
2013
2014
2015
2016
Cholangiocarcinoma (n = 16)
Miscellaneous (n = 20)
Hepatoblastoma (n = 2)
HCC (n = 310)
Malignancy at Transplantation(n = 337 Pts/348 Ca; 23.3% of patients)
© copyright ANLTU Data to 31 December 2016
1 1 1 1 13
2 1 1
5
8 7 75 5
8
14
11 10
14
9
16
13
20
13
17 20
17
22
1 1
2
2
3
24
2 2
1
1
3
3
2
2
2
5
6
2
3
5
3
0
5
10
15
20
25
30
Pre
199
0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Unknown Pre Tx: Found in Explant (n = 57)
Known Pre Tx: Confirmed at Explant (n = 248)
Chemo or Injection Pre Tx: No Tumour at Explant (n = 5)
HCC at Transplantation(n = 310)
Data to 31 December 2016 © copyright ANLTU 59
© copyright ANLTU Data to 31 December 2016
Cancer in Liver Transplant Recipients1986 - 2016
At Transplant (1544 patients) Patients (n,%)
Liver cancer as primary diagnosis 146 9.5%
Liver cancer as secondary diagnosis 193 12.5%
No. of Patients with a cancer diagnosis at transplant 339 22.0%
Post Transplant
Recurrent liver cancer 38 2.5% of all pts, 11.2% of cancer at tx pts
De novo non-skin cancer 123 8.0% of all pts, 36.3% of cancer at tx pts
De novo skin cancer 208 13.5% of all pts, 61.4 % of cancer at tx pts
No. of Patients with a post transplant cancer 369 23.9% of all pts
Patients with multiple cancers 208 13.5% of all pts
Pre transplant cancer developed de novo cancer 62 18.3% of cancer at tx pts
Transferred from donor 4
Developed non-skin cancer within 90 days 1
© copyright ANLTU Data to 31 December 2016
025
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urvi
ving
0 5 10 15 20 25Years Post Transplant
HCC vs EraPrimary and Secondary Indication
2007 – 2016 (n = 198)
1997 – 2006 (n = 101)
1986 – 1996 (n = 11)
p = ns
1yr 5yr 10yr 15yr 20yr 25yr 30yr
2007 - 2016No at risk 161 62
Actuarial Survival % 93 76
1997 - 2006No at risk 87 71 61 21
Actuarial Survival % 86 70 60 52
1986 - 1996No at risk 11 8 8 5 3
Actuarial Survival % 73 64 64 45 27
Data to 31 December 2016 © copyright ANLTU 60
© copyright ANLTU Data to 31 December 2016
025
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100
% S
urvi
ving
0 5 10 15 20 25 30Years Post Transplant
Benign Disease vs Malignancy
Benign (n = 1205)
Malignant (n = 337)
p < .05
1yr 5yr 10yr 15yr 20yr 25yr 30yr
BenignNo at risk 992 723 490 282 150 90 3
Actuarial Survival % 88 81 72 64 55 46 45
MalignantNo at risk 278 151 72 29 6 2
Actuarial Survival % 90 72 63 53 40 40
© copyright ANLTU Data to 31 December 2016
025
5075
100
% S
urvi
ving
0 5 10 15 20 25 30Years Post Transplant
Primary and Secondary HCC vs No HCC
No HCC (n = 1351)
With HCC (n = 324)
p = ns
1yr 5yr 10yr 15yr 20yr 25yr 30yr
No HCCNo at risk 1088 790 529 3041 163 64 3
Actuarial Survival % 86 79 70 62 53 45 44
With HCCNo at risk 266 146 68 25 3
Actuarial Survival % 90 74 65 56 45
Data to 31 December 2016 © copyright ANLTU 61
De Novo Non Skin Cancer Post Transplant
© copyright ANLTU Data to 31 December 2016
De Novo Cancer (Excluding Skin)n = 123 Pts, 133 Ca; 8.5% pts transplanted
No Male Female
Age of
patients
(years)
Time to diagnosis
(months)
Died of This
Cancer
Died
Other
Alimentary 48 38 1013 - 78
(m = 59)
6 - 266
(m = 74)24 50% 8
Lymphoma (inc PTLD) 31 18 131 - 70
(m = 49)
4 -281
(m = 104)9 29% 6
Genitourinary 16 13 321 - 74
(m = 59)
2 - 228
(m = 1163)2 13% 5
Respiratory 15 12 329 - 71
(m = 55)
7 - 193
(m = 81)8 53% 0
Breast 9 0 930 - 60
(m = 44)
50 - 252
(m = 135)6 67% 1
Endocrine 8 2 636 - 70
(m = 48)
14 - 144
(m = 56)2 25% 0
CNS 3 1 266 - 79
(m = 75)
14 - 210
(m = 93)2 67% 0
Bone 1 0 1 69 69 1 100% 0
Fibrous Histiocytoma 1 0 1 62 120 0 0
Kaposi’s 1 1 0 32 48 0 1
Total 133 85 481 - 80
(m = 56)
0 - 281
(m = 83)72 54% 21
NB: m = median
© copyright ANLTU Data to 31 December 2016
De Novo Cancer (Excluding Skin)n = 123 Pts, 133 Ca; 8.5% pts transplanted
Breast7%
CNS2%
Endocrine6%
Genitourinary12%
Kaposi's Sarcoma
1%
Lymphoma23%
Respiratory11%
Lower GI25%
Pancreas4%
Upper GI7%
Fibrous Histiocytoma1%Bone
1%
Alimentary40%
Data to 31 December 2016 © copyright ANLTU 62
Pre Transplant Liver Disease and De Novo Non Skin Cancer
© copyright ANLTU Data to 31 December 2016
Pre Transplant Liver Disease andDe Novo Cancer (Excluding Skin)
n = 133
7
7
5
4
3
1 1 1
0
1
2
3
4
5
6
7
PSC + Autoimmune29/133; 22% of all De Novo
4
2 2 2 2
1 1
0
1
2
3
4
5
6
7
HBV15/133; 133% of all De Novo
© copyright ANLTU Data to 31 December 2016
Pre Transplant Liver Disease andDe Novo Cancer (Excluding Skin)
n = 133
6 6
4
7
2 2
1 1
0
1
2
3
4
5
6
7
8
HCV29/133; 22% of all De Novo
8
5 5
2
3
1 1
0
1
2
3
4
5
6
7
8
Alcohol25/133; 19% of all De Novo
Data to 31 December 2016 © copyright ANLTU 63
© copyright ANLTU Data to 31 December 2016
12 129
5
1
7 6
1
3
4
3
4
2
3
3
1
5
4
1
0
5
10
15
20
25
30
PSC + AI HCV ALD HBV PBC
CNS (n = 1)
Bone (n = 1)
Fibrous Histiocytoma (n = 1)
Respiratory (n = 9)
Kaposi's Sarcoma (n = 1)
Genitourinary (n = 12)
Endocrine (n = 7)
Lymphoma (n = 17)
Alimentary (n = 39)
Primary Liver Disease andDe Novo Cancer (Excluding Skin)
© copyright ANLTU Data to 31 December 2016
5
16
14
13
1
3
5
1 1 1
4
3
11
2 2
3
8
1
3
6
10
12
1
5
3
6
1
0
2
4
6
8
10
12
14
16
0 - 6 months 6 - 12 months 1 - 5 years 5 - 10 years >10 years
Alimentary (n = 48)
Breast (n = 9)
CNS (n = 3)
Endocrine (n = 8)
Genitourinary (n = 16)
Kaposi's Sarcoma (n = 1)
Lymphoma (n = 31)
Respiratory (n = 15)
Fibrous Histiocytoma (n = 1)
Bone (n = ?)
Time to DiagnosisDe Novo Cancer (Excluding Skin)
Data to 31 December 2016 © copyright ANLTU 64
Cumulative Risk of Diagnosis of Cancer
© copyright ANLTU Data to 31 December 2016
Cumulative Risk of Diagnosis of CancerFollowing Liver Transplantation 1986 – 2016
0
20
40
60
80
100
0 5 10 15 20 25Years Post Tx
Any Cancer
Skin
De Novo Non Skin
Age Matched Gen. Pop