anzltr 26th report- 31.12.14 pdf · brisbane, melbourne, perth, sydney) and new zealand (auckland)....

INSIDE BACK COVERCD Included

SLIDESReport PowerPoint

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 4

Brisbane

Sydney

Melbourne

dn

ala

eZ

w

eN

Perth

Auckland

26TH

R E P O R T

Adelaide

AUSTRALIA & NEW ZEALANDAUSTRALIA & NEW ZEALAND

© copyright ANZLTR Data to 31.12.2014

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© copyright ANZLTR Data to 31.12.2014

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 is funded by the Australian Organ and Tissue Authority.

CITATION

The suggested citation for this report is as follows: ANZLT Registry Report 2014 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 22.0.

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]

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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 Cancer

Liver Malignancy as Primary or Secondary Diagnosis

- Type, Incidence, Survival & Mortality

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

41-46

46-51

51-52

52

53

54

55

56

57

CONTENTS

26TH

ANZLT REGISTRY

R E P O R T

DATA TO 31/12/2014 © copyright ANZLTR Data to 31.12.2014

PrefacePreface

1.

PREFACE

We are pleased to present the 26th Report of the Australia and New Zealand Liver

Transplant Registry (ANZLTR). This report contains data to the 31st December 2014

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.

We are grateful to the Australian Government, through the Australian Organ and

Tissue Authority, for their ongoing financial support.

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

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SummarySummary

2.

SUMMARY

5. Between January 1985 and 31st December 2014, 4864 orthotopic liver transplants (OLT) were performed in Australia and New Zealand on 4506 patients, 3711 adult patients [82%] and 795 children ( < 16 years) [18%]. The median age of all recipients was 48.3 years. The ages ranged from 24 days to 73.1 years. There is a significant difference in gender distribution between children (M=48%) and adults (M=66%).

6. Two hundred and sixty-three new patients were transplanted in 2014 compared with 264 in 2013.

7. The trend to increasing age of adult recipients in recent years continued and the overall adult median age is now 51.2 years. The median age of new adult recipients in 2010-14 was 54.3 years.

8-9. In 2014, 6 fewer transplants were performed than in 2013 [278 vs 284]. Split grafts continue to make a significant contribution to the total number of paediatric transplants performed providing 18 of 42 [43%] grafts in 2014 and 237 of 900 [26%] overall. In children, other reduced size grafts have been used in 392 [44%] cases including 73 living donor grafts. One child has been treated with liver cell implantation. Of adult patients, 284 have received reduced size grafts - 241 split liver grafts (including 1 as auxiliary graft), 30 other reduced size grafts (1 as auxiliary graft) and 13 living donor grafts. Two domino transplants of a whole liver have 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 22.9% of recipients and chronic hepatitis B [CVH : HBV] in 6.0 %. Full details of specific diagnoses categories by age group are listed in the Appendices for - Metabolic disorders (Appendix II), Other diseases (Appendix III) and Fulminant Hepatic Failure (Appendix IV).

12-15. The number of patients transplanted with non alcoholic fatty liver disease [ NAFLD/NASH] as the primary diagnosis continued to increase with 16 new patients transplanted in 2014 bringing the total to 111. 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 2010-14 compared with the previous eras, the number of patients with a primary diagnosis of hepatocellular carcinoma [HCC] is increasing each year and now account for 14% in 2010-14. The majority of these patients have 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 2014 was 47%.

16. Overall 1 year patient survival of all patients is 89.5% at 1 year, 82% at 5 years and 73.5% at 10 years. Children have a significantly better survival rate than adults with an actuarial survival of 72% 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 had poorer longer term outcomes. 18-19. Patient survival in later cohorts show 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 2010-14 cohort was 93% for all patients [93% for children, 94% 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 78%.

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 77% at 5 years with significantly better graft survival longer term in children. Survival was significantly worse in second grafts in both children and adults. Third grafts in adults have better outcomes than in children.

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 [10% PSC, PBC, AIH and 8% 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 percent of all deaths occurred within 6 months of transplant. Deaths from early graft failure were 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 particularly in children surviving 15 years or longer.

34. There was a slight fall in the number of cadaveric donors in 2014 with 272 grafts transplanted from deceased donors. The number of livers split to produce two transplantable grafts was 18 in 2014. Fifteen liver grafts donated after cardiac death were transplanted. The number of people on the waiting list at 31 December 2014 was higher than the number on the waiting list at 31 December 2013.

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

36. Eighty-eight patients [73 children, 15 adults] have now received a living donor graft with 6 performed in 2014. In 82 patients the living donor graft was a primary graft, in 5 as a second and 1 as a third graft. The median age of the donors was 34.0 years with a range of 19.0 to 54.5 years. Two adult grafts were domino whole liver graft.

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4.

SummarySummary

SUMMARY

37. Waiting list activity for 2014 shows the number of patients listed for transplantation continued to increase with 204 remaining on the waiting list at 31 December 2014. Patient delistings due to death, becoming too ill or tumour [HCC] progression accounted for 8% of all delistings while 278 [49%] were transplanted. Thirty patients were listed as urgent in 2014 [8 with initial listing as Category 1 and 22 Category 2]. Seven [88%] of Category 1 and 21 [95%] of Category 2 patients had a positive outcome.

38-39. Median waiting times tended to be higher in 2014 in some blood groups. Blood group B patients had the longest waiting times.

40- 42. 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 950 (21%) patients were transplanted who had a liver malignancy – 384 (9%) as a primary diagnosis and 572 (13%) as a secondary diagnosis or incidental tumour, with Hepatocellular Carcinoma being the most common. Post transplant 127 (13%) of these patients developed a recurrent cancer whilst in 113 (12%) of these patients' death was related to their initial cancer.

42. There continues to be an increase in the number of patients being transplanted for primary malignancy.

43-46. Patient survival was significantly worse in the 857 (20%) patients with pre-transplant liver malignancy compared with patients with other forms of liver disease with the exception of those with a diagnosis of Hepatocellular Carcinoma and Hepatoblastoma whose survival rates are close to those with other liver diseases. Of these 106 (12%) died from their malignancy. Those with Cholangiocarinoma had significantly poorer survival. The number of patients transplanted with liver cancer present at transplant has increased significantly in the last decade from 247 (1995-2005) to 643 (2005 -14).

46-51. Three hundred and fifty-two de novo non-skin types of cancer developed in 323 (7%) recipients. Twenty seven patients developed more than one de novo cancer. The three most common categories of de novo non-skin cancer were – cancers of the Alimentary Tract (125), Lymphoma (91) and Genitourinary (47) The incidence of de novo non-skin cancers appears to be related to the type of pre-transplant underlying disease. Most notable is the significant incidence of de novo non-skin malignancy in patients with underlying Primary Sclerosing Cholangitis, alcoholic cirrhosis and HCV (p<0.0001).

51-52. Six hundred and fifty-four patients (15%) developed skin cancers with a peak 1 - 3years after transplantation for appearance of first cancer. Multiple skin cancers developed in 316 patients. Thirty-two patients developed Melanoma.

The cumulative risk of diagnosis of any cancer post transplant is approaching 40% by 20 years.

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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

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Year of Transplant

Summary Statistics - Age and Gender

ALL PATIENTS TRANSPLANTED

Cumulative Number of Patients & Transplants

Children [<16y] Adults Total

Patients 795 3711 4506

Age

Mean ± SD 4.5 ± 4.5y 49.0 ± 11.6y 41.1 ± 20.0y

Median 2.4y 51.2y 48.3y

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

Gender

Female 414 (52%) 1277 (34%) 1691 (37.5%)

Male 380 (48%) 2434 (66%) 2814 (62.5%)

Surviving 642 (81%) 2604 (70%) 3246 (72%)

5.


Num

ber

Transplants

(n=4864)

Patients

(n=4506)

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

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5,000

2013

2014

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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

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

3,200

0

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=3711)

Children (n=794)

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3,600

2013

Age Group

Adult (n=3711)

Children (n=794)

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

2013

260

280

2014

3,800

2014

224

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7.


Number of Recipients By Age at Primary TransplantN=4506

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 = 48.3yRange 24d - 73.1y

1,200

1,300

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Ag

e a

t tr

an

spla

nt

Era

40

20

0

60

80

1985 - 89 1990 - 94 1995 - 99 2000 - 04 2005 - 09 2010 - 14


2.5y 2.9y 2.5y 2.5y 2.2y

P=0.045

43.9y45.9y

48.1y50.2y

52.2y

P<0.001

54.3y

1.9y

Adult (n=3711) Median = 51.2y [16.0 - 73.1y]

Children (n=794) Median = 2.4y [24d - 15.9y]

Age Group

1,400

184261 229

120

695

1,004

1,443

433

136

70

50

30

10

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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

100

80

20

120

140

160

40

60

180

200

220

0

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240

260

280

3,750

4,0001985

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

Age Group

Adult (n=3964)

Children (n=900)

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

2013

2014

Adult (n=3964)

Children (n=900)

Age Group

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9.


Type of Graft by YearSplit vs Reduced vs Whole

Adults (n = 3964)

Children (n = 900)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

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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

2013

2014

Liver cells

Split

Reduced

Whole

Type of Graft

Split - LRD

n= 1

n= 237 (26%)

n= 319 (36%)

n= 270 (30%)

n= 73 (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

2013

2014

240

Split

Reduced

Whole

Type of Graft

Split - LRD

* 2 domino liver

n= 241 (6%)

n= 30 (0.7 %)

n= 3680 (93%)*

n= 13 (0.3%)

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

Section 2

SECTION 2 : PRIMARY DIAGNOSIS

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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

BA10.5%

MET6.3%

ALD10.2%

CC4.2%

PBC4.8%

CVH : HCV18.9%

CVH : HBV4.9%

OTH8.7%

FHF9.6%

MAL8.4%

PSC8.9%

*

**

See Appendices for details *

CAH : AI3.4%

CVH : B/C/D1.1%

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Primary Diseases of Adult Recipientsn = 3711


11.

Primary Diseases of Childrenn =794

OTH12%

FHF11.1%

MAL

PSC

MET14.6%

CAH:AI

BA55%

BA

MET4.5%

ALD12.4%

CC4.7%

PBC5.9%

0.9%

CVH : HCV22.9%

CAH:AI3.9%

OTH8.1%

FHF9.3%

MAL9.6%

PSC10.5%

CC2.1%

1%

3.1%

1%

CVH : HBV6.0%

CVH : B/C/D 1.3%

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

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Primary Diseases


12.Primary Diagnosis Group

Perc

ent of N

ew

Patie

nts

Perc

ent of

New

Patie

nts

Adults (n = 3711)

Children (n=794)

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%

MAL

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2005-09 (n=152)

2000-04 (n=112)

1995-99 (n=117)

1990-94 (n=141)

1985-89 (n=75)

Era

2010-14 (n=197)

2005-09 (n=810)

2000-04 (n=748)

1995-99 (n=580)

1990-94 (n=411)

1985-89 (n=130)

Era

2010-14 (n=1032)

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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 - 14(n=1032)

7%

3%

8%

8%

1%

12%

5%

5%

14%

3%

6%

NAFLD/NASH

Era

6%

2%

2%

2%

2%

1%

15%

13%

10%

74%

55%

42% 25%

28%38%

12%

34% 28%

13%

19%

9%

8%

3%

7%

5%

76%

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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

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220

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

2013

2014

Hep B/C/D

Hep B

Hep C

HCC

ALD

NAFLD/NASH

Primary Diagnosis

Other diseases

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15.

Hepatitis C 849 7 252 5 226

Hepatitis B 220 3 83 1 6

Hepatitis 51 9 7

BD/BC/BCD

HCC + cirrhosis 328 167 88 7 13 69

ALD 461 22 3 59 9

NAFLD 111 2 24 5

Other 1691 18 8 55 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%

20%

74%

6%

Year of Transplant

Hepatitis diagnosis

Count

2000 2001 2002 2003 2004 2005 2006 2007 2008

80

40

0

2009

n = Hepatitis C Hepatitis BHepatitis

B,C HCC NAFLD ALD

TOTAL 3711

Secondary / Tertiary diagnosis

13%

83%

4%

2010-14[n=466]

2010 2011

Hepatitis Negative

Mixed B/C/D

Hepatitis C

Hepatitis B

Chronic viral hepatitis

2012

26TH

ANZLT REGISTRY

R E P O R T


20

60

120

100

160

140

200

180

220

2013 2014

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

Section 3

SECTION 3 : PATIENT SURVIVAL

26TH

ANZLT REGISTRY

R E P O R T


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Patie

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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

90%

89%87%

85%

85%

81%

82%

72%

80%76%

61%

49%

Adult (n=3711)

Children (n=794)

Age group

P<0.001

100

90

80

70

60

50

40

30

20

0

72%

26

10

42%

28

26TH

ANZLT REGISTRY

R E P O R T


29

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

No. at risk 3784 3134 2631 1626 873 74

Actuarial Survival (%)

89.5% 85% 82% 73.5% 64% 49%

N = 4505Median = 6.6y

Range (0-29.8y)

20y

368

55%

30

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

Median 6.4y (0-28.4y)

Median 8.1y (0-29.8y)

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Patient Survival by Age at Primary Transplant

17.


Patie

nt S

urv

ival (

%)


Children n= 794

Adults n = 3711

Patie

nt S

urv

ival (

%)

100

90

80

70

60

50

40

30

20

10

0

p =ns

Age Strata

<1y (n=184)

1 - 2y (n=261)

3 -9y (n=229)

1y 5y 10y 15y

86% 83% 82% 80%

87% 81% 77% 75%

91% 88% 84% 84%

20y

77%

71%

83%

10 - 15y (n=120) 93% 90% 87% 83% 76%

3y

84%

82%

90%

92%

100

90

80

70

60

50

40

30

20

10

0

p = 0.000

Age Strata

16-39y (n=695)

40-49y (n=1004)

50-59y (n=1443)

60-64y (n=433)

>=65y (n=136)

1y 5y 10y 15y

89% 84% 77% 69%

90% 81% 72% 62%

90% 81% 71% 57%

88% 77% 67%

86% 72% 58%

52%

20y

58%

52%

44%

40%

35%

26TH

ANZLT REGISTRY

R E P O R T


25y

68%

68%

78%

76%

3y

86%

85%

85%

82%

83% 44%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

25y

54%

48%

28%

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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%

76%

67%

51%

41%

36%

78%

54%

Era

1985-89 (n=205)

1990-94 (n=552)

1995-99 (n=697)

2000-04 (n=860)

2005-09 (n=962)2010-14 (n=1229)

93%

48%

26TH

ANZLT REGISTRY

R E P O R T


35%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

71%

47%

63%

60%

63%

87% CL

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Patient Survival - Adults

19.

Patient Survival - Children



Children n = 794

Patie

nt S

urv

ival (

%)

Patie

nt S

urv

ival (

%)

Adults n = 3711

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%78%

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%

2010-14 (n=197)

93%

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%

83%

75%

60%

44%

p < 0.001

100

90

80

70

60

50

40

30

20

10

0

2010-14 (n=1032)

94%

48%

35%

26TH

ANZLT REGISTRY

R E P O R T


10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

91%

92%

71%

87%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

75%

60%

39%

50%

75%

83%

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20.

Patient Survival by Type of Primary Graft[Deceased donors]

Adults n = 3697

Children n = 725


Patie

nt S

urv

ival (

%)

Patie

nt S

urv

ival (

%)


100

90

80

70

60

50

40

30

20

10

p = 0.003

Type of Graft

Reduced (n=279)

Split (n=210)

Whole (n= 236)

92%

93%

84%

88%

89%

79%

82%83%

76%

77%

74%

86%

71%

82%

100

90

80

70

60

50

40

30

20

10

0

Type of Graft

Reduced (n=28)

Split (n=234)

Whole (3435)

P = NS90%

89%

68%

81%

82%

68%

61%

76%

53%

48%

52%

72%

63%63%

77%

41%

0

64%

26TH

ANZLT REGISTRY

R E P O R T


10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

82%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

53%

63%

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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=173)

> 8 kg (n=613)

< 5 kg (n=8)

P = NS91%

82%

75%

87%

79%

75%

81%83%

76%

77%

75%

75%

75%

75%

71%

73%

26TH

ANZLT REGISTRY

R E P O R T


10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

75%

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Time Post-transplant (years)22.


(1) Adults [excluding FHF] n = 1280


(2) Adults [excluding FHF] n = 2085

Patie

nt S

urv

ival (

%)

Patie

nt S

urv

ival (

%)

39%

CVH : B,C,D

n = 5y

9 100%

Diagnosis Group

CVH : Hep B 221 81%

CVH : Hep C 849 79%

Malignancy 355 74%

PBC 218 86%

PSC 392 83%

CVH : B,C 16 94%

CVH : B,D 25 86%

10y 15y

100% 100%

78%

66% 53%

64%

76% 66%

75% 63%

66%

62%

94%

20y

53%

48%

84%

86%

60%

p = 0.003

100%

48%

26TH

ANZLT REGISTRY

R E P O R T


Biliary atresia

n = 5y 10y 15y

35 85% 81% 76%

Diagnosis Group

CAH: AI 145 81% 72%

Metabolic diseases 166 83% 75% 63%

Alcholic cirrhosis 461 84% 72%

Cryptogenic cirrhosis 174 81% 70% 56%

Other 299 83% 73% 68%

58%

57%

20y

50%

46%

56%

54%

35%

p = NS

81%

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 29 30

76%

25y

45%

46%

51%

36%

30%

35%

25y

45%

40%

60%

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 29 30

84%

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(3) Paediatric recipients [excluding FHF] n = 707

(4) Fulminant hepatic failure n = 433

Patie

nt S

urv

ival (

%)

Patie

nt S

urv

ival (

%)

23.



Patie

nt S

urv

ival (

%)

p = NS

Age group

Adult (n=346)

Child (n=87)

All Patients (n=433)

p = NS82%

68%

66%

75%

78%

78%

76%79%

73%

73%

75%

59%

81%

65%

57%

100

90

80

70

60

50

40

30

20

10

0

Biliary atresia

n = 5y 10y 15y

437 85% 82% 81%

Diagnosis Group

Autoimmune hepatitis 9

Cryptogenic cirrhosis 17 87% 78% 78%

Malignancy 25 71% 53%

Metabolic diseases 116 88% 84% 84%

Other 95 88% 86% 84%

20y

76%

81%

84%

36%

62%

PSC 8 88%

36%

88%

26TH

ANZLT REGISTRY

R E P O R T


100

90

80

70

60

50

40

30

20

10

0

88% 88%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

52%

65%

49%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

100% 100% 75%

25y

74%

69%

84%

62%

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Adults CVH: Hepatitis C n = 849

Adults CVH: Hepatitis B n = 221

Malignancy Adults and Childrenn=380

Adults (n = 355)Children (n=25)

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

48%

P = NS

2010-14 288

72%

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=21)

2000-04 (n=61)

Era

2010-14 (n=163)

2005-09 (n=110)

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= 54)2000-04 (n= 58)

Era

2010-14 (n= 36)

84%

81%

62%80%62%

54%

22%

11% 11%

79%

2005-09 (n= 38)

92%

77%

67%

97%

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

26TH

ANZLT REGISTRY

R E P O R T


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

100

90

80

70

60

50

40

30

20

10

0

23

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

70%

83%67%

57%

25

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

Section 4

SECTION 4 : GRAFT OUTCOME

26TH

ANZLT REGISTRY

R E P O R T


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25.

Graft Survival - All Grafts


Gra

ft S

urv

ival (

%)

Gra

ft S

urv

ival (

%)

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

No. at risk 3906 3180 2643 1594 848 66

Actuarial Survival (%)

86% 80% 77% 67% 59% 43%

N = 4864

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

82%

86%

77%

75%

70%

67%

68%

56%

63%

57%

37%

Adult (n=3964)

Children (n=900)

Age group

P<0.001

44%

20y

350

48%


26TH

ANZLT REGISTRY

R E P O R T


10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

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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

87%

77%

74%

78%

69%

63%

69%

59%

52%

60%

59%

45%

50%

35%

43%

p <0.001

Graft Number

1st Grafts (n=4505) [92.6%]

2nd Grafts (n=328) [6.7%]

3rd Grafts (n=31) [0.6%]

All Grafts (n= 4864)

84%

64%

66%

78%

57%

57%

73%

46%

48%

71%66%

p <0.001

Graft Number

1st Grafts (n=794) [88%]

2nd Grafts (n=92) [10.4%]

3rd Grafts (n=14) [1.6%]

Children (n= 900)

100

90

80

70

60

50

40

30

20

10

0

87%88%

77%

78%

65%

78%

68%

78%

53%57%

78%

p <0.001

Graft Number

1st Grafts (n=3711) [93.6%]

2nd Grafts (n=236) [6%]

3rd Grafts (n=17) [0.4%]

100

90

80

70

60

50

40

30

20

10

46%

44%

Adult(n= 3964)

35%

38%

61%

43%

33%

0

0

26TH

ANZLT REGISTRY

R E P O R T


10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 3010 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 3010 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

46%

35%

59%

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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 29 3010 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

P = NS

Type of Graft

Split (n=241)

Reduced (n=30)

Whole (n=3678)

100

90

80

70

60

50

40

30

20

10

0

83%

63%

87%

77%

60%

76%

65%

47%

67%

55%

47%

57%

37%

55%

44%

47%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

27.

Graft Survival by Type of Graft [Deceased Donors]



All Grafts (n= 4775)

Children (n= 826)

Adult(n= 3949)

Gra

ft S

urv

ival (

%)

Gra

ft S

urv

ival (

%)

Gra

ft S

urv

ival (

%)

P = NS

Type of Graft

Split (n=478)

Reduced (n=349)

Whole (n=3948)

85%

73%

87%

77%

66%

77%

67%

60%

68%59%59%

58%

40%

59%

46%49%

P= 0.001

Type of Graft

Split (n=237)

Reduced (n=319)

Whole (n=270)

86%

74%

88%

79%

67%

81%

69%

61%

78%

60%

63%

76%

63%

69%

56%

55%

50%

100

90

80

70

60

50

40

30

20

10

0

26TH

ANZLT REGISTRY

R E P O R T


59%

10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 3010 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28 29 30

63%

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28.


Biliary

PNF/poor graft function

Vascular

Rejection

Recurrent HBV /HCV

Recurrent PBC/PSC/CAH:AI

Other

Age Group

Adults(n= 236)

Children(n= 122)

12%

10%

3%

30%

8%

37%

13%

7%

10%

8%

1 %613%

33%

26TH

ANZLT REGISTRY

R E P O R TIndication for Retransplantation n = 358 (327 2nd grafts, 31 3rd grafts)

20%

6%8%8%

13%

11%

34%


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29.


Num

ber

of G

rafts

46 (13%) 52 (15%) 60 (17%) 33 (9%) 88 (22%) 52 (14%)N = 35 (10%)

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 = 358 (327 2nd grafts, 31 3rd grafts)

30(13%)

35 (15%)

45(19%)

23(10%)

48(20%)

34(14%)

N = 21(9%)

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

0

5

10

15

20

25

30

40

Children (n=122) Adults (n=236)

16 (13%)

17 (14%)

15 (12%)

10(8%)

32(26%)

18(15%)

N = 14(12%)

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

0

5

10

15

20

25 35

30

65

26TH

ANZLT REGISTRY

R E P O R T


75

70

35 50

80

45

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Section 5Cause of Patient Death

Section 5

SECTION 5 : CAUSE OF PATIENT DEATH

26TH

ANZLT REGISTRY

R E P O R T


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Causes of Death

30.


All Patients n = 1259

Operative

Respiratory

Cerebrovascular

Cardiovascular

Sepsis

Malignancy - recurrent

Malignancy - de novo

Recurrent HBV / HCV

Rejection

Other

Miscellaneous

Gastrointestinal

Graft failure

*

*

See Appendix V for details *

26TH

ANZLT REGISTRY

R E P O R T


9%

15%3%

6%

7%

8%

2%

15%

10%

11%

8%

6%

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Causes of Death in Adultn = 1107

31.

Operative

Respiratory

Cerebrovascular

Cardiovascular

Sepsis



Recurrent HBV / HCV

Rejection

Other

Miscellaneous

Gastrointestinal Graft failure

*

*


Causes of Death in Childrenn =152


26TH

ANZLT REGISTRY

R E P O R T


4%

20%

9% 2% 5%

14%

8%

4%

19%7%

9%

8%

16% 6%

6%

8%

2%

14%

11%12%

9%

5%

3%

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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-7 8 30 1m-6m 6m - 1y 1y-5y 5y-10y 10y - 15y >15y

32.


Cause of Death by Time Post Transplant

Operative

Respiratory

Cerebrovascular

Cardiovascular

Sepsis



Gastrointestinal

N = 126 (10%) 290 (23%)108 (9%) 140 (11%) 92 (7%) 223 (18%)

Recurrent HBV / HCV

Rejection

Other [graft failure]

Miscellaneous

159 (13%) 121 (10%)

*

*


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

0%

20%

40%

60%

80%

100%

26TH

ANZLT REGISTRY

R E P O R T


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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-7 8 30 1m-6m 6m - 1y 1y-5y >5y-10y 10y - 15y >15y

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-7 8 30 1m -6m 6m - 1y 1y-5y >5y-10y 10y - 15y >15y

33.


N = 25 (16%) 28 (19%)26 (17%) 28 (18%) 8 (5%) 16 (11%) 6 (4%) 15 (10%)

Cause of Death by Time Post Transplant Children (n=152)

Operative

Respiratory

Cerebrovascular

Cardiovascular

Sepsis



Gastrointestinal Recurrent HBV / HCV

Rejection

Other [graft failure]

Miscellaneous

N = 101 (9%) 262 (24%)82 (7%) 112 (10%) 84 (8%) 207 (19%) 153 (14%) 106 (10%)

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

Cause of Death by Time Post Transplant Adult (n=1107)

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%

26TH

ANZLT REGISTRY

R E P O R T


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Section 6Deceased Donor Information

Section 6

SECTION 6 : DECEASED DONOR INFORMATION

26TH

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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 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

2013 40 66/5 54/7 23/5 33 25 258

2014 44 45/7 62/8 27/4 25 32 254

4 1613* 5 14 15

26TH

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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

Graft Survival by Donor AgeN = 4649

2010 - 2014

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= 279

n= 211n= 1542n= 1627n= 745n= 245

Donor Age by EraN = 4410

n = 96 593 728 868 923

28.6y

36.4y

40.0y43.9y

46.1y

N = 4410Median Age: 40.2yRange: 3d - 84.5y

P < 0.001

1202

20.3y

23 25

26TH

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R E P O R T


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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

26TH

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36.

Living Donor TransplantationN = 88

SECTION 7 : LIVING DONOR TRANSPLANTATION

Donor age

Median

Range

Mother

Father

Son

Daughter

Grandmother

Grandfather

Sister

Brother

Aunt

Uncle

Family friend

Cousin

Spouse

Donor gender

Male

Female

Child [n=73] Adult [n=15]

-

35.3y

19.9 - 54.5y

-

18

35

-

-

1

1

-

2

6

1

5

4

-

-

30.4y

22.8 - 54.3y

-

-

-

4

1

-

-

3

3

-

-

1

-

1

-

43

30

-

9

6

All [n=88]

-

34y

19 - 54.5y

-

18

35

4

1

1

1

3

5

6

1

6

4

1

-

52

36

Recipient Age Group

*

* 2 x whole liver domino transplant

Donor relationship

26TH

ANZLT REGISTRY

R E P O R T


Surv

ival (

%)


90

80

70

60

50

40

30

20

10

0

100

(82 patients received LD graft as first graft)

All Patients (n= 82)

All Grafts (n= 88)o nd rd[82 x 1 , 5 x 2 , 1 x, 3 ]

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

Paediatric Patient Survival (n= 68)

Adult Patient Survival (n= 14)

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

Section 8

SECTION 8 : WAITING LIST

26TH

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Waiting List Activity[ Data 1/1/10 - 31/12/14]

37.


Outcome of Initial Urgent Listing

[* Patient declined, malignancy, drug use, infection, further investigations, medical]

TRANSPLANTED

IMPROVED

DIED / TOO SICK

OTHER TREATMENT

2010

(n=19)

13

1

5

-

OUTCOME

}74%

2011

(n=15)

12

-

3

-

}80%6

1

1

-

}88%

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 2014

565

Delisted

Adult

235 [47%]

187

500

15

10

15

16

22

Paediatric

43 [66%]

17

65

3

-

-

2

-

2014

78 5

[ %]278 49

204 [36%]

83

}[ ]8%18

22

1015

18*

4

1

1

-

OUTCOME

175

335

248 [49%]

194 [38%]

510

12

12

12

16

12

2010

}8%

68 [13%]

*

2

-

-

-

1 active

31/12/11

26TH

ANZLT REGISTRY

R E P O R T

194

336

253 [49%]

192 [36%]

530

17

17

20

12

19

2011

}8%

85 [13%]

*

164

-

88

51

164

8

3

4

5

5

-

401

190

153

401

10

7

11

13

17

25 58

}8%}5%


2014

CATEGORY 1

N=8 Adultn=6

Paediatricn=2

TRANSPLANTED

IMPROVED

DIED / TOO SICK

OTHER TREATMENT

2010

(n=30)

23

5

1 / 1

-

OUTCOME

}93%

2011

(n=28)

22

2

3

}86%18

3

-

}95%12

2

-

6

1

-

2014

CATEGORY 2

N=22 Adultn=14

Paediatricn=8

1 active

31/12/14

192

351

268 [50%]

186 [34%]

543

29

16

10

17

17

2012

}8%

89[13%]

*

2012

(n=16)

11

2

3

-

}

1 active

31/12/12

2012

(n=19)

14

3

1

}

81%

89%

[*1 temporary listing chronic patient; later transplanted]

1 active

31/12/14

2013

(n=19)

11

3

5

-

}

1 active

31/12/13

2013

(n=29)

22

4

2

}

74%

89%

*

-

186

360

284 [52%]

164 [34%]

546

26

11

16

24

21

2013

}10%

98[18%]

*

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Outcome by Blood Group

Waiting Time to Transplant 2014

A O B AB TOTAL

n=

Not transplanted

Transplanted

215 (38%) 254 (45%) 78 (14%) 20 (3%) 567

Blood Group

92 144 48 5 289

123 (57%) 110 (43%) 30 (38%) 15 (75%) 278 (49%)

*

**

* % 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

26TH

ANZLT REGISTRY

R E P O R T


P= NS

40

42

91d 120d83d61dMedian

n= 123 (44%) 110 (40%)30 (11%) 15 (5%)

44

46

48

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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 2014Waiting

Listed 2014TransplantListed 2014

DelistedListed pre '14

Waiting

Listed pre '14

TransplantListed pre '14

Delisted

8

4

0

20

12

16

32

24

28

44

40

36

52

48

6

4

20

1614

12

810

26

2422

18

20

36

34

32

2830

38

56

-2

60

48

46

44

40

42

AB B OA

50

52

54

5658

60

26TH

ANZLT REGISTRY

R E P O R T


Median waiting time to transplant= 82d (0-46m)

Median waiting time listed patients 31/12/14

= 161d (1d-90m)

Median= 81d 70d 134d 117d

Median 297d 291d

38d 56d108d

547d

Transplanted

Not transplanted

Patient Outcome

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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

26TH

ANZLT REGISTRY

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Cancer in Liver Transplant Recipientsn = 4506

40.


Liver Cancer as Primary Diagnosisn = 384/4506

26TH

ANZLT REGISTRY

R E P O R T


At Tx

Liver Cancer as indication for Transplant 384 (9%)

Liver Ca as a Secondary Diagnosis 572 (13%) 574 Ca

Total 950* (21%)

Post Tx

Recurrent Liver Ca 127 (3% of all pts, 13% pts with Ca at Tx)

De Novo Ca 323 (7%) 352 Ca

Skin Ca 653 (14%)

Total 1103 (24%)

Multiple Cancer types (non skin and skin) 215 (5% of all pts)

Multiple non skin cancers 88 (2% of all pts)

Transferred from Donor 2

Developed non skin Ca < 90days 9

Total number pts. transplanted = 4506

* 2 pts had primary and a secondary liver cancer; 2 pts had multiple secondary liver cancers

TYPE OF CA No DIEDDIED OF THIS

CA

HEPATOCELLULAR CA 342 76 39 (11%)

HEPATOBLASTOMA 22 5 4 (18%)

FIBROLAMELLAR 6 5 2 (33%)

CARCINOID 4 4 4 (100%)

EPITHELOID HAEMANGIOENDOTHELIOMA 4 0 0

CHOLANGIOCARCINOMA 2 1 1 (50%)

ANGIOSARCOMA 1 1 1 (100%)

GASTRINOMA 1 1 1 (100%)

PANCREATIC ISLET CELL 1 1 1 (100%)

ERYTHROID LEUKAEMIA 1 1 1 (100%)

TOTALS 384 (9% of pts)95 (25% of

those with PCa)

54 (14% of those with

PCa)

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Overall SurvivalPrimary Liver Cancern =384/4506 (9% of pts transplanted)

41.


Overall SurvivalPrimary Liver Cancern= 384/4506 (9%)

26TH

ANZLT REGISTRY

R E P O R T


% S

urv

ivin

g

0

20

40

60

80

100

0 5 10 15 20

Years Post Tx

n =384/4506 (9% of pts transplanted)

5y 10y 15y 20y

No. at risk 136 45 15 4

Actuarial Survival % 74 62 56 45

% S

urv

ivin

g

0

20

40

60

80

100

0 5 10 15 20

Years Post Tx

HCC (n=342)

Hepatoblastoma (n=22)

Fibrolamellar (n=6)

CC (n=2)

Other (n=12)

p< 0.05

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Primary Liver Cancer Actuarial Survival Summaryn = 384/4506

42.


Primary Liver Cancer Incidence n= 384/4506

26TH

ANZLT REGISTRY

R E P O R T


1yr 5yr 10yr 15yr 20yr

HCC (n=342)n 275 121 39 11 2

% 92 75 64 64 53

Hepatoblastoma (n=22)n 20 9 3 3 2

% 95 79 53 53 53

Other (n=12)n 10 5 2 2 2

% 83 41 21 21 21

Fibrolamellar (n=6)n 6 4 4 2

% 83 67 65 22

CC (n=2)n 2 1

% 50 50

23

24

1 13 3

24

12

4

9

4

8 8

5

8

1516

22

1817

34 34

41

25

40

48

0

10

20

30

40

50

60

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Overall SurvivalLiver Cancer as a Secondary Diagnosis

43.


Liver Cancer as a Secondary Diagnosisn = 572/4506

26TH

ANZLT REGISTRY

R E P O R T


* 2 patients had 2 secondary cancers

% S

urv

ivin

g

No DiedDied of This

Cancer

HEPATOCELLULAR CA* 523 143 40 (8%)

CHOLANGIO CA 37 29 17 (46%)

OTHER 7 5 2 (29%)

FIBROLAMELLAR 4 0 0

HEPATOBLASTOMA* 3 1 0

Total574* in 572 pts (13%)

178 (31% of pts with SCa)

59 (10% of pts with SCa)

0

20

40

60

80

100

0 5 10 15 20

Years Post Tx

n=593/4506 pts (13%)

5y 10y 15y 20y

No. at risk 271 134 33 5

Actuarial Survival % 74 65 47 34

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Liver Cancer as a Secondary Diagnosisn =593/ 4506 (13%)

44.


Secondary Liver Cancer Actuarial Survival Summaryn =572/ 4506 (13%)

26TH

ANZLT REGISTRY

R E P O R T


% S

urv

ivin

g

0

20

40

60

80

100

0 5 10 15 20

Years Post Tx

Fibrolamellar (n=4)

Hepatoblastoma (n=3)

HCC (n=544)

Other (n=7)

CC (n=37)

p<0.0001

1yr 5yr 10yr 15yr

HCC (n=523)n 420 251 124 30

% 89 77 69 51

CC (n=37)n 31 13 8 2

% 81 38 27 6

Other (n=7)n 7 4 2

% 86 57 19

Fibrolamellar (n=4)n 4 4 4 4

% 100 100 100 100

Hepatoblastoma (n=3)n 3 3 2 2

% 67 67 67 67

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45.


Liver Cancer (Primary or Secondary Diagnosis) n = 953/4506

Patient Actuarial SurvivalBenign Disease vs Pre Transplant Liver Malignancyn = 4506

26TH

ANZLT REGISTRY

R E P O R T


* 2 patients had 2 secondary cancers; 2 patients had a primary and secondary liver malignancy

TYPE OF CA No. DIED DIED OF THIS CA

HEPATOCELLULAR CA* 864 219 79 (9%)

CHOLANGIOCARCINOMA* 39 30 18 (46%)

HEPATOBLASTOMA* 25 6 4 (16%)

FIBROLAMELLAR 10 5 2 (20%)

CARCINOID 4 4 4 (100%)

ADENOCARCINOMA 5 4 1 (20%)

EPITHELOID HAEMANGIOENDOTHELIOMA 4 0 0

ANGIOSARCOMA 2 2 2 (100%)

GASTRINOMA 1 1 1 (100%)

PANCREATIC ISLET CELL 1 1 1 (100%)

ERYTHROID LEUKAEMIA 1 1 1 (100%)

TOTALS958* Ca in 953

pts (21% of pts)

273 (29%of those with

Ca)113 (12% of those with Ca

at Tx)

0

20

40

60

80

100

0 5 10 15 20

% Surviving

Years Post Tx

Benign disease (n=3553)

Malignant disease (n=953)

p=0.000

5y 10y 15y 20y 25y

Benign Disease

n2226 1451 828 364 75

% Surviving83 75 67 57 51

Malignant Disease

n406 178 47 8

% Surviving74 64 49 37

p<0.0001C

LIC

K H

ER

E t

o g

o t

o

pa

ge

Co

nte

nts

Liver Cancer at Transplantationn = 954/4506 (21%)

46.


De Novo Non - Skin Cancern = 323/4506

26TH

ANZLT REGISTRY

R E P O R T


* 2 patients had 2 secondary cancers; 2 patients had a primary and secondary liver malignancy

28 23 4026

234

603

1985 -1994 1995 - 2004 2005 - 2014

Other (n=91*)

HCC (n=863)

* 27 patients had more than 1 de novo cancer

m = median

No Male Female Age of pts (yrs)Time to diagnosis

(mths)Died of This

Cancer

Alimentary* 125 95 30 12.6 – 83 (m 59) 3 – 281 (m 54) 59 (45%)

Lymphoma* 91 54 37 1– 70 (m 48) 1 – 217 (m 5) 32 (37%)

Genitourinary* 47 31 16 21 – 75 (m 61) 2 – 348 (m 20) 4 (10%)

Breast 25 - 25 30 – 74 (m 55) 11 – 241 (m 79) 10 (36%)

Respiratory 33 27 6 29 – 75(m 60) 7 – 212 (m 39) 25 (76%)

Endocrine 9 4 5 35 – 70 (m 56) 35 – 213 (m 64) 3 (33%)

CNS 7 5 2 16 – 75 (m 57) 14– 211 (m 99) 6 (86%)

Kaposi’s 5 4 1 32 – 65 (m 51) 2 – 48 (m 16) 0

Leukaemia 4 2 2 3 – 66 (m 43) 16 – 155 (m 37) 0

Miscellaneous 4 2 2 62 – 73 (m 68) 60– 234 (m 87) 1(25%)

Total*352 ca in

323 pts 225 127 1 – 83 (m 56) 1 – 348 (m 53)140 (43% of pts with Ca)

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47.


Time to De Novo Non - Skin Cancern = 4506352 cancers in 323 pts (7% of all pts)

De Novo Non - Skin Cancer vs All Patientsn = 4506

26TH

ANZLT REGISTRY

R E P O R T


0

5

10

15

20

25

30

35

40

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

Alimentary Tract

Breast

CNS

Endocrine

Genitourinary

Kaposi's sarcoma

Leukaemia

Lymphoma

Miscellaneous

Respiratory

0

20

40

60

80

100

0 5 10 15 20 25

% Surviving

Years Post Tx

Other Pts (n=4183)De Novo (n=323)

p<0.0001

5y 10y 15y 20y

All Ptsn 1529 793 318 42

% Surviving 80 73 66 58

De Novo

n 78 55 34 15

% Surviving 77 66 46 25

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48.


De Novo Non - Skin Cancern = 323/4506 (7%)

26TH

ANZLT REGISTRY

R E P O R T


Breast8%

CNS2%

Endocrine3%

Genitourinary13%

Kaposi's1%

Leukaemia1%

Lymphoma25%

Miscellaneous1%

Respiratory9%

Upper GI11%

Lower GI24%

Pancreas3%

Alimentary, 39%

Pre Transplant Liver Disease andDe Novo Non - Skin Cancern = 323/4506 pts (7%)

0 10 20 30 40 50 60 70 80

Cryptogenic

Biliary Atresia

HBV

Autoimmune

Metabolic

PBC

Other

Alcohol

PSC

HCV

Alimentary TractBreastCNSEndocrineGenitourinaryKaposi's sarcomaLeukaemiaLymphomaOtherRespiratory

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49.


Pre Transplant Primary Liver Disease andDe Novo Non - Skin Cancer n = 323 (352 Ca)/4506 pts (7%)

Pre Transplant Primary Disease andDe Novo Non - Skin Cancer n = 323 (352 Ca)/4506 pts (7%)

26TH

ANZLT REGISTRY

R E P O R T


Bre

ast

Alim

enta

ry

Lym

phom

a

Resp

irato

ry

Genito

urin

ary

Kaposi's

Leuka

em

ia

CN

S

Alim

enta

ry

Resp

irato

ry

Lym

phom

a

Genito

urin

ary

CN

S

Oth

er

25

13 13

8

4

1 1 1 1

0

5

10

15

20

25

30HCV - 67/352

19% of de novo Ca24

9

76

21

0

5

10

15

20

25

30Alcohol - 49/352

14% of de novo Ca

Merke

l Cell

8

7

6 6

5

4 4

3

2

1 1

0

2

4

6

8

10

12

14

16

Genitourinary Cancers44 (47 Ca)/323 14% de novo pts

3

4

10

5

9

16

0

2

4

6

8

10

12

14

16Genitourinary Cancers

Time to Diagnosis

44 (47ca)/323 14% de novo pts

PS

C

HC

V

Meta

bolic

Alco

hol

Fulm

inan

t

PB

C

Oth

er

CC

Malig

nancy

HB

V

AI

<3m

ths

3-1

2m

ths

1-3

yrs

3-5

yrs

5-1

0yrs

>10yrs

CL

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50.


De Novo Non - Skin CancerGenitourinary Tract Incidencen = 47/352 cancers (13%)

26TH

ANZLT REGISTRY

R E P O R T


Prostate Cervix Testis UterusKidney Bladder FallopianTube

Urethra

16

9 98

1 1 1 1 1

Vagina

0

5

10

15

20

Pre Transplant Primary Disease andDe Novo Non - Skin Cancer n = 323 (352 Ca)/4506 pts (7%)

PS

C

HC

V

Meta

bolic

Alco

hol

Fu

lmin

ant

PB

C

Oth

er

CC

Malig

nan

cy

HB

V

AI

<3

mth

s

3-1

2m

ths

1-3

yrs

3-5

yrs

5-1

0yrs

>1

0yrs

32

2524

12

86

54 4 4

1

0

5

10

15

20

25

30

35

40Alimentary Cancers

125/352 (36% de novo Ca)

1

11

25

22

33

35

0

5

10

15

20

25

30

35

40

Alimentary Cancers

Time to Diagnosis

125 /352 (36% de novo Ca)

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51.


26TH

ANZLT REGISTRY

R E P O R T


Time to Melanoma Skin Cancer Development Post Tx.n =450632 (0.7% of all pts)

De Novo Non - Skin CancerAlimentary Tract Incidencen = 125/352 cancers (36%)

58

28

11 10 97

1 1

0

10

20

30

40

50

60

70

Colon Head andneck

Stomach Rectum Pancreas Liver Lung Appendix

0

2

4

6

8

10

12

14

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

Melanoma

CL

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52.


Time to 1st Skin Cancer Development654/4506 (15% of all pts)

26TH

ANZLT REGISTRY

R E P O R T


Time to Multiple Skin Cancer Development316/4506 (5% of all pts)

Cumulative Risk of Diagnosis of Cancer Following Liver Tx. 1985-2014Patients at Risk (4506)

0

10

20

30

40

50

60

70

80

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

0

100

200

300

400

500

600

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

0

20

40

60

80

100

0 5 10 15 20

Years Post Tx

Any Ca

Skin

Non skin (includes recurrent primary and secondary liver cancer)

De Novo Non skin

Age-Matched Gen. Pop

BCC

Melanoma

Other

SCC

BCC

Melanoma

Other

SCC

CL

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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/surgical/pages/livertrans/6984/

WA Liver Transplantation Service

Sir Charles Gairdner 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 Lady Cilento Children's Hospital

Stanley Street

SOUTH BRISBANE QLD 4101

Starship Children’s Hospital

Park Road

AUCKLAND

New Zealand

Australian National Liver Transplant Unit

Royal Prince Alfred Hospital

Missenden Road

CAMPERDOWN NSW 2050

Email: [email protected]

http://www.anltu.com.au/

Victorian Liver Transplantation Unit

The Austin Hospital

Studley Road

HEIDELBERG VIC 3084

http://www.austin.org.au/page/209

Queensland Liver Transplant Service

Princess Alexandra Hospital

Ipswich Road

WOOLLOONGABBA QLD 4102

and

and

and

53.

26TH

ANZLT REGISTRY

R E P O R T


and

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Appendix IIAppendix II

APPENDIX

54.

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

Maple syrup urine disease 4Amyloidosis 2Bile acid Transport disorder 2Protein C deficiency 2Propionic acidemia 2Methylmalonic acidemiaFamilial immunodeficiencyMitochondrial diseasePorphyria

38

10

0

4

3

6

1

1

13

9

4

20

8

117

49

1

35

6

29

2

0

0

6

6

0

4

28

166

Age group

Primary Diagnosis

87

11

35

10

32

8

1

1

19

15

4

24

36

283

*

**

OTC deficiency 13Citrullinemia 4Argininosuccinic aciduria 4Carbamyl phosphate synthetase deficiency 3

* **

Child Adult

Total

26TH

ANZLT REGISTRY

R E P O R T


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Appendix IIIAppendix III

APPENDIX

55.

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

29

2

0

0

2

2

4

1

0

1

0

4

0

4

0

0

0

1

20

3

0

12

9

94

7

0

2

3

20

2

10

30

2

3

4

1

1

0

7

111

22

12

5

13

4

18

22

299

36

2

2

3

22

4

14

31

2

4

4

5

1

4

7

111

22

13

25

16

4

30

31

393

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

26TH

ANZLT REGISTRY

R E P O R T


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Appendix IVAppendix IV

APPENDIX

56.

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-G

Acute - Hepatitis E

Acute - Post liver resection/trauma

Subacute - Budd Chiari

Subacute - Wilson's

Subacute Autoimmune hepatitis

Subacute - Drug / Herbs

Subacute - Unknown / unspecified

Subacute - Hepatitis A

Subacute - Hepatitis B

Subacute - Non A-G

Total

0

8

2

0

44

4

3

1

1

0

13

0

1

1

2

1

1

5

0

0

0

87

2

16

0

6

94

15

25

8

3

60

20

1

3

2

4

17

15

30

2

19

4

346

2

24

2

6

138

19

28

9

4

60

33

1

4

3

6

18

16

35

2

19

4

433

Primary Diagnosis

Children Adult

TotalAge group

26TH

ANZLT REGISTRY

R E P O R T


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Appendix VAppendix V

APPENDIX

57.

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)

8

16

24

Graft failure - other

Children Adult

TotalAge group

Hepatic artery

Portal vein

Hepatic vein

Vascular thrombosis

4

2

2

9

7

-

13

9

2

19

Renal Failure

Graft vs Host disease

Social

Sudden death (cause unknown)

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

8

71

79

Miscellaneous Children Adult

Multiorgan failure

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

1 33

34

-

7

7

1

16

17

2

29

31

1

19

20

-

2

3

12

7

19

2

15

26

29

85

114

TOTAL

13

175

188

TOTAL

-

17

0

19

3

4

4

-

3

21

4

26TH

ANZLT REGISTRY

R E P O R T


CL

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ts

anzltr 26th report- 31.12.14 pdf · brisbane, melbourne, perth, sydney) and new zealand (auckland)....

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