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Fr om the C om bine d R e g is t r i e s
o f the A us t r a l i a n a nd N e w Ze a la nd
L iv e r Tr a ns p la n t C e n t r e s
D A T A T O 3 1 - 1 2 - 2 0 1 2
Brisbane
Sydney
Melbourne
dn
ala
eZ
w
eN
Perth
Auckland
24TH
R E P O R T
Adelaide
AUSTRALIA & NEW ZEALANDAUSTRALIA & NEW ZEALAND
© copyright ANZLTR Data to 31.12.2012
© copyright ANZLTR Data to 31.12.2012
COORDINATING CENTRE
ANZLT Registry www.anzltr.orgPrincess Alexandra HospitalIpswich RdWOOLLOONGABBA, QLD, 4102
Professor Stephen Lynch EditorMs Glenda Balderson Editor/Liaison OfficerMs Debra Cormack Graphics
Phone (61-7) 3176 2385 G.Balderson Fax (61-7) 3176 2999 G.Balderson
Email [email protected]
MANAGEMENT COMMITTEE
Professor L. DelreviereSir Charles Gairdner Hospital, WA
Professor R.M. JonesAustin Hospital, VIC
Professor S.V.LynchPrincess Alexandra Hospital, QLD
Professor G.W. McCaughanRoyal Prince Alfred Hospital, NSW
Professor S. MunnAuckland Hospital, NEW ZEALAND
Dr. R. PadburyFlinders Medical Centre, SA
MS G.A. BaldersonPrincess Alexandra Hospital, QLD
FUNDING
ANZLTR receives majority funding from the Australian Organ and Tissue Authority supplemented by funds from Janssen-Cilag Pty Ltd.
CITATION
The suggested citation for this report is as follows : ANZLT Registry Report 2012 Australia and New Zealand Liver Transplant Registry Brisbane, QLD, AUSTRALIA Editors: S.V. Lynch, G.A. Balderson
STATISTICAL METHODS
Kaplan-Meier survival curves have been produced using IBM SPSS® for Windows™ Release 21.0.
ACKNOWLEDGMENT
The Cancer Registry is maintained at Transplantation Services, Royal Prince Alfred Hospital, Sydney. Report prepared by Pamela Dilworth, Marie Mulhearn and Dr Deborah Verran.
Director: Professor G.W McCaughanAll queries to: Dr Deborah Verran Email [email protected]
ContentsContentsPreface
Summary
Section 1
Summary Statistics
Number of New Patients
Age of Recipients
Number of Transplants and Type of Graft by Year
Section 2
Primary Diseases of Recipients
Primary Diagnosis by Era
Chronic Viral Hepatitis - Adults Recipients
Section 3
Patient Survival
Patient Survival by Age at Primary Transplant and Era of Transplant
Patient Survival by Type of Primary Graft
Patient Survival by Weight at Transplant - Children
Patient Survival by Primary Disease
Section 4
Graft Survival
Indication for Retransplantation
Section 5
Causes of Patient Death
Section 6
Deceased Donors by Year
Donor Age and graft outcome
Section 7
Living Donor Transplantation
Section 8
Waiting List Activity and Outcome
Waiting Time by Blood Group and Outcome
Section 9
Summary and Type of Primary Liver Cancer
Primary Liver Malignancy - Survival, Incidence and Mortality
Liver Cancer as Secondary Diagnosis - Type and Outcome
De Novo Non Skin Cancers
Skin Cancers Post Transplant
Cumulative Rate of Cancer Development
Appendix I - Transplant Units Australia and New Zealand
Appendix II - Metabolic Disorders
Appendix III - Other Diseases
Appendix IV - Fulminant Hepatic Failure
Appendix V - Causes of Patient Death
1
2-4
Demographic Data
5
6
7
8-9
Primary Diagnosis
10-11
12-13
14-15
Patient Survival
16
17-19
20
21
22-24
Graft Outcome
25-27
28-29
Causes of Death
30-33
Deceased Donor Information
34
35
Living Donor Transplantation
36
Waiting List
37-38
39
Liver Transplantation and Cancer
40
41-43
43-46
47-50
51
51
52
53
54
55
56
CONTENTS
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
PrefacePreface
1.
PREFACE
We are pleased to present the 24th Report of the Australia and New Zealand Liver
Transplant Registry (ANZLTR). This report contains data to the 31st December 2012
and analyses the cumulative data since the establishment of the first liver
transplantation unit in Australia or New Zealand in 1985.
The Australia and New Zealand Liver Transplant Registry (ANZLTR) is a
collaborative effort of the liver transplantation centres in Australia (Adelaide,
Brisbane, Melbourne, Perth, Sydney) and New Zealand (Auckland). The Registry is
supervised by the Management Committee which is involved in the ongoing
supervision of the development of the Registry. The members of the Management
Committee are listed on the front page.
Donor data have been supplied by the Australia and New Zealand Organ Donor
Registry and we thank them for their collaboration.
The Editors would also like to thank the staff of all the Liver Transplant Units who
contribute their data by direct entry into the ANZLTR database. A full list of the Units
and their contact information can be found in Appendix I. In particular we are grateful
to the efforts of Pamela Dilworth, Program Manager and Marie Mulhearn for their
continuing contribution to the maintenance of the Cancer Registry which is based at
the Royal Prince Alfred Hospital, Sydney and who, together with Dr Deborah Verran,
prepare the Cancer Report.
The registry has financial support and we are grateful to the Australian Government,
through the Australian Organ and Tissue Authority, for their financial contribution.
Some additional funds are received from Janssen-Cilag Pty Ltd on an ad hoc basis.
Comments are always welcome and should be forwarded to the Coordinating
Centre at the contact information listed on the front page as should requests for
further copies of this Report. The report is now also available on the ANZLTR public
web site www.anzltr.org from where the report can be downloaded. Slides are
available on request from the Coordinating Centre.
Stephen Lynch
Glenda Balderson
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SummarySummary
2.
SUMMARY
5. Between January 1985 and 31st December 2012, 4302 orthotopic liver transplants (OLT) were performed in Australia and New Zealand on 3980 patients, 3266 adult patients [82%] and 714 children ( < 16 years) [18%]. The median age of all recipients was 47.6 years. The ages ranged from 24 days to 73.1 years. There is a significant difference in gender distribution between children (M=47%) and adults (M=65%)
6. Two hundred and forty-six new patients were transplanted in 2012 compared with 225 in 2011.
7. The trend to increasing age of adult recipients in recent years continued and the overall adult median age is now 50.4 years. The median age of new adult recipients in 2010-12 was 54.0 years.
8-9. In 2015,15 more transplants were performed than in 2011 [268 vs 253]. Split grafts continue to make a significant contribution to the total number of paediatric transplants performed providing 21 of 46 [46%] grafts in 2012 and 197 of 812 [24%] overall. In children, other reduced size grafts have been used in 367 [45%] cases including 63 living donor grafts. One child has been treated with liver cell implantation. Of adult patients, 245 have received reduced size grafts - 203 split liver grafts (including 1 as auxiliary graft), 29 other reduced size grafts (1 as auxiliary graft) and 13 living donor grafts. One domino transplant of a whole liver has been performed.
10-11. Overall, chronic viral hepatitis (CVH) is the most common primary indication for liver transplantation. In children biliary atresia (BA) is the most common primary disease. In adults chronic hepatitis C [CVH : HCV] is the primary disease in 22.4% of recipients and chronic hepatitis B [CVH : HBV] in 6.2 %. Full details of specific diagnoses categories by age group are listed in the Appendices for - Metabolic disorders (Appendix II), Other diseases (Appendix III), Fulminant Hepatic Failure (Appendix IV).
12-15. The number of patients transplanted for non alcoholic fatty liver disease [ NAFLD/NASH] continued to increase with 12 new patients transplanted in 2011 bringing the total to 81. While the proportion of adult patients transplanted with a primary diagnosis of chronic viral Hepatitis B, C or B/C/D has fallen slightly in era 2010-12 compared with the previous eras, the number with a primary diagnosis of hepatocellular carcinoma [HCC] is higher at 13% with the majority of these patients having a secondary diagnosis of CVH. When patients with either primary or secondary diagnosis of Hepatitis B,C or both are included, the overall incidence of CVH in new adult patients in 2012 was 45%.
16. Overall 1 year patient survival of all patients is 89% at 1 year, 81% at 5 years and 72% at 10 years. Children have a significantly better survival rate than adults with an actuarial survival of 71% at 25 years post-transplant.
17. Whilst older children had superior early survival than infants and babies, long term survival is similar. Older adult recipients (60-65 and >65 years) had poorer longer term outcomes.
18-19. Patient survival in 2000-04 cohort shows continued improvement in outcome for the first 10
years compared with earlier cohorts. This is seen in both children and adults. One year patient survival in 2010-12 cohort was 92% for all patients [94% for children, 92% for adults].
20. In both children and adults, there are worse early outcomes in patients receiving a deceased donor reduced size graft as their primary graft compared with split liver graft or whole liver grafts. Split liver grafts and whole livers have similar early outcomes in both children and adults.
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3.
SummarySummary
SUMMARY
21. Smaller children and babies weighing < 8 kg at the time of transplant had inferior early survival compared to heavier children but similar long term results.
22. Adult patients transplanted for biliary atresia or hepatitis virus co-infections had the best longer term survival while those whose primary disease was malignancy or Hepatitis C have significantly lower survival rates.
23. In children, patient survival was similar for all disease groups though lower in patients whose primary disease was malignancy. There were no differences in survival between adults and children transplanted for fulminant hepatic failure [acute and sub-acute] with overall 5 year survival of 77%.
24. Recent cohorts of adult patients with a primary diagnosis of hepatitis B continue to show a significantly improved survival which is not seen in adult patients with hepatitis C as primary disease. Patients transplanted for malignancy continue to have a poor outcome but some improvement in longer term outcome is seen in patients transplanted since 2000.
25-26. Overall graft survival was 76% at 5 years with significantly better graft survival longer term in children . Survival was significantly worse in second and third grafts in both children and adults.
27. Overall split liver grafts have similar graft survival to whole liver grafts. Reduced grafts have lower graft survival in the early post-transplant years in both children and adults.
28-29. Vascular complications and rejection were the commonest indications for re-transplantation. Twelve percent of retransplants were due to poor early graft function. Re-transplantation for recurrent disease was most prevalent in adults [9% PSC, PBC, AIH and 9% HBV, HCV].
30-33. Sepsis is the most frequent cause of death in both adults and children. Full details of Miscellaneous and Other Graft Failure deaths are listed in Appendix V. Thirty-two percent of all deaths occurred within 6 months of transplant. Early graft failure was due to poor or no early graft function. By 1 year malignancy and graft failure from recurrent disease or chronic rejection cause most deaths. Deaths due to de novo malignancy and chronic rejection are increasing with longer survival time.
34. There was an increase in the number of cadaveric donors in 2012 with 261 grafts transplanted from deceased donors. The number of livers split to produce two transplantable grafts was 21 in 2012. Seventeen liver grafts donated after cardiac death were transplanted. The number of people on the waiting list at 31 December 2012 was similar to the number on the waiting list at 31 December 2011.
35. Donor age has increased significantly in recent years. Long term graft survival trends lower in several older donor age groups.
36. Seventy-seven patients [63 children, 14 adults] have now received a living donor graft with 7 performed in 2012. Seventy-one were transplanted as a primary graft, 5 as a second and 1 as a third graft. The median age of the donors was 33.8 years with a range of 20.1 to 54.5 years. One adult graft was a domino whole liver graft.
37. This data has been expanded to include a breakdown of total waiting list activity for 2012 by age group. The number of patients listed for transplantation continued to increase in 2012 with 182 remaining on the waiting list at 31 December 2012. Patient delistings due to death, becoming too ill or tumour [HCC] progression accounted for 10% of all delistings while 268 [50%] were transplanted. Thirty five patients were listed as urgent in 2012[16 with initial listing as Category 1 and 19 Category 2]. Thirteen [81%] of Category 1 and 17 [89%] of Category 2 patients had a positive outcome.
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4.
SummarySummary
SUMMARY
38-39. Median waiting times tended to be higher in 2012 in some blood groups. Blood group O patients had the longest waiting times.
40. Cancer in liver transplant recipients was analysed from two perspectives. Firstly, those who had a liver cancer diagnosis at the time of transplantation (as primary, secondary or incidental) and secondly those who developed a cancer post transplantation (de novo skin and de novo non skin cancer). Overall 766 (18%) patients were transplanted who had a liver malignancy - 295 (7%) as a primary diagnosis and 471 (12%) as a secondary diagnosis or incidental tumour, with Hepatocellular carcinoma being the most common. Post transplant 113 (16%) of these patients developed a recurrent cancer whilst 97 patients' death was related to this initial type of tumour.
41-43. The longer term survival of patients with liver cancer is significantly poorer for the subgroup of patients with Hepatoblastoma. There also continues to be an increase in the number of patients being transplanted for primary malignancy in the patient cohort for the time period of 2009-2012 with Hepatocullular Carcinoma being the most common underlying cause.
43-45. Four hundred and seventy one [12%] had liver cancer as a secondary or incidental diagnosis with hepatocellular carcinoma the most common. Of these 48 (10%) died from their malignancy. Those with cholangiocarcinoma had significantly poorer survival.
46. Patient survival was significantly worse in the 768 (19%) patients with pre transplant liver malignancy compared with patients with other forms of liver disease.
47-48. Three hundred and nine de novo non-skin cancers developed in 295 patients (7%). Eleven patients developed more than one type of de novo cancer. One hundred and twenty-two (41%) patients died from their de novo cancer. Cancers of the alimentary tract (114) and lymphoma (79) are the two most common types of de novo cancer.
49-50. For the alimentary tract cancers the colon was the predominate site (59). The incidence of de novo non-skin cancers appears to vary according to the diagnosed pre-transplant liver disease, with the incidence of de-novo non-skin malignancy in patients with Primary Sclerosing Cholangitis being statistically significantly higher than for the other underlying liver diseases (p<0.0001).
51. Nine hundred and forty eight patients (25%) developed 3809 skin cancers with 555 patients having multiple skin cancer types and 29 developed melanoma.
Of note, the cumulative risk of diagnosis of any cancer post transplant is approaching 40% by 20 years.
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Section 1D e m o g r a p h i c D a t a
Section 1
SECTION 1 : DEMOGRAPHIC DATA
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Year of Transplant
Summary Statistics - Age and Gender
ALL PATIENTS TRANSPLANTED
Cumulative Number of Patients & Transplants
Children [<16y] Adults Total
Patients 714 3266 3980
Age
Mean ± SD 4.5 ± 4.5y 48.5 ± 11.6y 40.6 ± 20.0y
Median 2.4y 50.4y 47.6y
Range 24d -15.9y 16.0 - 73.1y 24d - 73.1y
Gender
Female 381 (53%) 1146 (35%) 1527 (38%)
Male 333 (47%) 2120 (65%) 2453 (62%)
Surviving 573 (80%) 2314 (71%) 2887 (73%)
5.
SECTION 1 : DEMOGRAPHIC DATA
Num
ber
Transplants
(n=4302)
Patients
(n=3980)
2,000
1,500
1,000
500
0
1985
2,500
3,000
3,500
4,000
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
4,500
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Number of New Patients Transplanted by Year
Year of Transplant6.
SECTION 1 : DEMOGRAPHIC DATA
Cumulative Number of New Patients Transplanted
Num
ber
of P
atie
nts
Num
ber
of P
atie
nts
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
120
100
80
20
140
160
180
200
40
60
220
240
1,200
1,000
800
200
0
400
600
1,600
1,400
2,000
1,800
2,400
2,200
2,600
3,000
2,800
2010
2011
3,200
0
Age Group
Adult (n=3266)
Children (n=714)
2012
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
3,400
Age Group
Adult (n=3266)
Children (n=714)
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202
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
7.
SECTION 1 : DEMOGRAPHIC DATA
Number of Recipients By Age at Primary TransplantN=3980
Age Strata
Age at Primary Transplant by Era
Count
600
500
400
300
200
100
0
700
800
900
1,000
1,100
< 1y 1 - 2y 3 - 9y 40 - 49y16 - 39y10 - 15y 50 - 59y 60 - 64y >=65y
Median = 47.6yRange 24d - 73.1y
1,200
1,300
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ANZLT REGISTRY
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163
348
240 199
111
640
937
1,231
110
Ag
e a
t tr
an
spla
nt
Era
2.5y 2.9y 2.5y 2.5y 2.2y
P=ns
43.9y45.9y
48.1y50.2y
52.2y
P<0.001
Adult (n=3266) Median = 50.4y [16.0 - 73.1y]
Children (n=713) Median = 2.4y [24d - 15.9y]
Age Group
54.0y
1.8y
40
30
20
10
0
50
60
70
80
1985 - 89 1990 - 94 1995 - 99 2000 - 04 2005 - 09 2010 - 12
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
8.
SECTION 1 : DEMOGRAPHIC DATA
Number of Transplants by Year
Cumulative Number of Transplants
Num
ber
of T
ransp
lants
Num
ber
of T
ransp
lants
Year of Transplant
1,250
1,000
750
250
500
1,750
1,500
2,250
2,000
2,750
2,500
3,000
3,500
3,250
125
100
25
150
175
200
50
75
225
250
275
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Adult (n=3490)
Children (n=812)
Age Group
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
Age Group
Adult (n=3490)
Children (n=812)
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222
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
9.
SECTION 1 : DEMOGRAPHIC DATA
Type of Graft by YearSplit vs Reduced vs Whole
Adults (n = 3490)
Children (n = 812)N
um
ber
of G
rafts
Num
ber
of G
rafts
Year of Transplant
25
20
5
0
30
35
40
10
15
45
50
100
80
60
0
40
140
120
180
160
200
220
20
Liver cells
Split
Reduced
Whole
Type of Graft
Split - LRD
n= 1
n= 197 (24%)
n= 304 (37%)
n= 247 (31%)
n= 63 (8%)
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Split
Reduced
Whole
Type of Graft
Split - LRD
* 1 domino liver
n= 203 (6%)
n= 29 (0.6 %)
n= 3245 (93%)*
n= 13 (0.4%)
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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
SECTION 2 : PRIMARY DIAGNOSIS
10.
Diagnosis Group
- Biliary atresia
- Metabolic diseases
- Alcoholic cirrhosis
- Cryptogenic cirrhosis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Malignancy
- Fulminant hepatic failure
- Other diseases
- Chronic active hepatitis [autoimmune]
- Chronic viral hepatitis B
- Chronic viral hepatitis C
- Chronic viral hepatitis B / C / D
BA10.9%
MET6.5%
ALD10.3%
CC4.6%
PBC5.2%
CVH : HCV18.4%
CVH : HBV5.1%
OTH8.5%
FHF9.7%
MAL7.5%
PSC8.8%
*
**
See Appendices for details *
CAH : AI3.5%
CVH : B/C/D1.1%
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Primary Diseases of Adult Recipientsn = 3266
SECTION 2 : PRIMARY DIAGNOSIS
11.
Primary Diseases of Childrenn =714
OTH11.9%
FHF10.5%
MAL
PSC
MET14.4%
CAH:AI
BA56.0%
BA
MET4.8%
ALD12.5%
CC5.1%
PBC6.3%
1%
CVH : HCV22.4%
CAH:AI4.1%
OTH7.7%
FHF9.5%
MAL8.5%
PSC10.6%
CC2.2%
1.0%
2.9%
1.0%
CVH : HBV6.2%
CVH : B/C/D1.4%
MAL
FHF
OTH
CAH : AI
CVH : HBV
CVH : HCV
CVH : B/C/D
- Malignancy
- Fulminant hepatic failure
- Other diseases
- Chronic active hepatitis [autoimmune]
- Chronic viral hepatitis B
- Chronic viral hepatitis C
- Chronic viral hepatitis B / C / D
BA
MET
ALD
CC
PBC
PSC
- Biliary atresia
- Metabolic diseases
- Alcoholic cirrhosis
- Cryptogenic cirrhosis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
Diagnosis Group
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Primary Diseases
SECTION 2 : PRIMARY DIAGNOSIS
12.Primary Diagnosis Group
Perc
ent of N
ew
Patie
nts
Perc
ent of
New
Patie
nts
Adults (n = 3266)
Children (n=713)
BiliaryAtresia
Metabolic diseases
Cryptogeniccirrhosis
PSC Malignancy FHF Other diseases
CAH : AI
CAH:AI
OTHFHFPSCPBCCCMETBA ALD CVH:Mixed
CAH:HBV
CAH:HCV
30%
10%
0%
40%
50%
60%
20%
70%
10%
5%
0%
15%
20%
25%
30%
2005-09 (n=152)
2000-04 (n=112)
1995-99 (n=117)
1990-94 (n=141)
1985-89 (n=75)
Era
2010-12 (n=116)
MAL
2005-09 (n=810)
2000-04 (n=748)
1995-99 (n=580)
1990-94 (n=411)
1985-89 (n=130)
Era
2010-12 (n=587)
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Adult Primary Diagnosis by Era
SECTION 2 : PRIMARY DIAGNOSIS
13.
Adult Diagnosis
Hep B/C/D
ALD
Other diseases
Hep C
HCC
Hep B
1985 - 89 (n=130)
1990 -94 (n-411)
1995 - 99 (n=580)
2000 - 04(n=748)
2005 - 09(n=810)
2010 - 12(n=587)
7%
3%
8%
8%
1%
12%
5%
5%
13%
3%
6%
NAFLD/NASH
Era
6%
2%
2%
2%
1%
1%
15%
13%
10%
74%
55%
42% 25%
28%37%
12%
35% 29%
14%
19%
9%
8%
3%
8%
5%75%
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Adult Primary Diagnosis by Year
SECTION 2 : PRIMARY DIAGNOSIS
14.
Year of Transplant
Count
80
40
0
120
200
160
180
140
100
60
20
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Hep B/C/D
Hep B
Hep C
HCC
ALD
NAFLD/NASH
Primary Diagnosis
Other diseases
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DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
SECTION 2 : PRIMARY DIAGNOSIS
15.
Hepatitis C 731 7 186 3 188
Hepatitis B 203 3 73 5
Hepatitis 43 5 7
BD/BC/BCD
HCC + cirrhosis 260 120 68 6 5 42
ALD 408 18 3 49 6
NAFLD 81 2 13 3
Other 1539 15 8 49 3 22
Pri
mar
y D
iagn
osis
Type of Chronic Viral Hepatitis in Adult Patients
Chronic Viral Hepatitis as Primary or Secondary Diagnosis in Adult Patients
1990-94[n=71]
1995-99[n=190]
2000-04[n=321]
2005-09[n=363]
Era
37%
59%
4%
33%
65%
2%
26%
68%
6%
19%
74%
6%
Year of Transplant
Hepatitis diagnosis
Count
2000 2001 2002 2003 2004 2005 2006 2007 2008
150
100
50
0
2009
n = Hepatitis C Hepatitis BHepatitis
B,C HCC NAFLD ALD
TOTAL 3266
Secondary / Tertiary diagnosis
11%
86%
3%
2010 - 12[n=253]
2010
200
2011
Hepatitis Negative
Mixed B/C/D
Hepatitis C
Hepatitis B
Chronic viral hepatitis
2012
24TH
ANZLT REGISTRY
R E P O R T
111
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Section 3P a t i e n t S u r v i v a l
Section 3
SECTION 3 : PATIENT SURVIVAL
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
16.
Patie
nt S
urv
ival (
%)
Patie
nt S
urv
ival (
%)
Time Post-transplant (years)
SECTION 3 : PATIENT SURVIVAL
Patient Survival Post Transplant
100
90
80
70
60
50
40
30
20
10
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25
0
27
89%
89%
86%
84%
84%
80%
80%
71%
78%74%
61%
48%
Adult (n=3266)
Children (n=714)
Age group
P<0.001
100
90
80
70
60
50
40
30
20
0
71%
26
1y 3y 5y 10y 15y 25y
No at risk 3303 2737 2264 1349 681 13
Actuarial Survival (%)
89% 84% 81% 72% 65% 48%
N = 3980
20y
242
55%
10
39%
28
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Patient Survival by Age at Primary Transplant
17.
Time Post-transplant (years)
Patie
nt S
urv
ival (
%)
SECTION 3 : PATIENT SURVIVAL
Children n= 713
Adults n = 3266
Patie
nt S
urv
ival (
%)
100
90
80
70
60
50
40
30
20
10
0
p =ns
Age Strata
<1y (n=163)
1 - 2y (n=240)
3 -9y (n=199)
1y 5y 10y 15y
85% 82% 80% 78%
87% 80% 76% 73%
91% 87% 83% 83%
20y
76%
70%
81%
10 - 15y (n=111) 93% 90% 86% 83% 73%
3y
84%
82%
89%
93%
100
90
80
70
60
50
40
30
20
10
0
p = 0.000
Age Strata
16-39y (n=640)
40-49y (n=937)
50-59y (n=1231)
60-64y (n=348)
>=65y (n=110)
1y 5y 10y 15y
89% 84% 76% 69%
90% 81% 71% 63%
89% 81% 70% 57%
87% 75% 64%
84% 67% 50%
54%
20y
57%
51%
35%
38%
33%
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
All Patient Survival by Year of Transplant
18.
SECTION 3 : PATIENT SURVIVAL
Time Post-transplant (years)
Patie
nt S
urv
ival (
%)
100
90
80
70
60
50
40
30
20
10
0
p < 0.00191%
70%
86%
84%
93%
60%
79%
77%
83%
85%
52%
71%
67%
60%
47%
40%
76%
64%
Era
1985-89 (n=205)
1990-94 (n=552)
1995-99 (n=697)
2000-04 (n=860)
2005-09 (n=962)2010-12 (n=703)
92%
51%
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Patient Survival - Adults
19.
Patient Survival - Children
SECTION 3 : PATIENT SURVIVAL
Time Post-transplant (years)
Children n = 713
Patie
nt S
urv
ival (
%)
Patie
nt S
urv
ival (
%)
Adults n = 3266
100
90
80
70
60
50
40
30
20
10
0
93%
88%
83%
77%
69%
61%
56% 56%
86%
p < 0.001
51%
78%
77%
86%
92%
1985-89 (n=75)1990-94 (n=141)1995-99 (n=117)2000-04 (n=112)
Era
2005-09 (n=152)
84%
81%
94%
2010-12 (n=116)
94%
84%
75%
Era
1985-89 (n=130)1990-94 (n=411)1995-99 (n=580)2000-04 (n=748)2005-09 (n=810)
91%
83%
70%
87% 83%
75%
59%
78%
64%
49%
69%
55%
42%
92%
29%
84%
75%
61%
43%
p < 0.001
100
90
80
70
60
50
40
30
20
10
0
2010-12 (n=587)
92%
48%
35%
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
20.
Patient Survival by Type of Primary Graft[Deceased donors]
Adults - n = 3253
Children - n = 655
SECTION 3 : PATIENT SURVIVAL
Patie
nt S
urv
ival (
%)
Patie
nt S
urv
ival (
%)
Time Post-transplant (years)
100
90
80
70
60
50
40
30
20
10
p = 0.02
Type of Graft
Reduced (n=265)
Split (n=173)
Whole (n= 216)
92%
92%
83%
88%
87%
78%
82%83%
75%
76%
72%
83%
70%
77%
100
90
80
70
60
50
40
30
20
10
0
Type of Graft
Reduced (n=27)
Split (n=196)
Whole (3030)
P = NS89%
86%
66%
80%
82%
66%
61%
73%
52%
47%
52%
71%
70% 66%
76%
39%
0
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
62%
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
21.
Patient Survival by Weight - Children
SECTION 3 : PATIENT SURVIVAL
Patie
nt S
urv
ival (
%)
Time Post-transplant (years)
100
90
80
70
60
50
40
30
20
10
0
Weight Group
5-8 kg (n=155)
> 8 kg (n=551)
< 5 kg (n=8)
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
P = NS91%
81%
75%
86%
77%
75%
80%
82%
74%
75%
74%
75%
74%
75% 74%
71%
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Time Post-transplant (years)22.
Patient Survival by Primary Disease
(1) Adults [excluding FHF] - n=1151
SECTION 3 : PATIENT SURVIVAL
(2) Adults [excluding FHF] - n = 1804
P
atie
nt S
urv
ival (
%)
Patie
nt S
urv
ival (
%)
100
90
80
70
60
50
40
30
20
10
0
Biliary atresia
n = 5y 10y 15y
34 84% 84% 84%
Diagnosis Group
CAH: AI 133 81% 71%
Metabolic diseases 156 82% 74% 62%
Alcholic cirrhosis 408 84% 73%
Cryptogenic cirrhosis 166 80% 68% 59%
Other 254 83% 70% 67%
59%
62%
20y
46%
46%
56%
49%
34%
p = NS
37%
CVH : B,C,D
n = 5y
9 100%
Diagnosis Group
CVH : Hep B 203 80%
CVH : Hep C 731 78%
Malignancy 277 72%
PBC 205 85%
PSC 345 81%
CVH : B,C 16 94%
CVH : B,D 18 89%
10y 15y
100% 100%
76%
65% 52%
62%
74% 64%
73% 64%
67%
58%
94%
20y
55%
48%
94%
89%
67%
p = 0.001
100
90
80
70
60
50
40
30
20
10
0
100%
35%
84%
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 26
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Time Post-transplant (years)
(3) Paediatric recipients [excluding FHF] - n= 638
(4) Fulminant hepatic failure n = 386
Patie
nt S
urv
ival (
%)
Patie
nt S
urv
ival (
%)
23.
Patient Survival by Primary Disease
SECTION 3 : PATIENT SURVIVAL
Patie
nt S
urv
ival (
%)
100
90
80
70
60
50
40
30
20
10
0
p = NS
Age group
Adult (n=311)Child (n=75)All Patients (n=386)
p = NS81%
67%63%
72%
78%
77%
74%77%
72%
72%
72%53%
80%
60%
55%
100
90
80
70
60
50
40
30
20
10
0
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
Biliary atresia
n = 5y 10y 15y
400 85% 81% 80%
Diagnosis Group
Autoimmune hepatitis 7
Cryptogenic cirrhosis 16 92% 83% 82%
Malignancy 21 64% 48%
Metabolic diseases 103 88% 83% 83%
Other 84 87% 85% 82%
20y
76%
80%
82%
24%
66%
PSC 7 86%
24%
86%
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 26
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Adults CVH: Hepatitis C n = 731
Adults CVH: Hepatitis B n = 203
Malignancy Adults and Childrenn=298
Adults (n = 277)Children (n=21)
Time Post-transplant (years)24.
Patient Survival by Primary Disease
SECTION 3 : PATIENT SURVIVAL
Patie
nt S
urv
ival (
%)
Patie
nt S
urv
ival (
%)
Patie
nt S
urv
ival (
%)
Era
1985-89
1990-94
1995-99
2000-04
n = 5y 10y 15y
4 75% 50% 50%
34 82% 59%
109 72%
188
38%
56%
82%
2005-09 226
47%
P = NS
2010-12 170
71%
100
90
80
70
60
50
40
30
20
10
0
100
90
80
70
60
50
40
30
20
10
0
p < 0.001
1985-89 (n=12)
1990-94 (n=13)
1995-99 (n=20)
2000-04 (n=61)
Era
2010-12 (n=82)
2005-09 (n=110)
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23
100
90
80
70
60
50
40
30
20
10
0
p <0.001
1985-89 (n=9)1990-94 (n= 26)
1995-99 (n= 55)2000-04 (n= 58)
Era
2010-12 (n= 17)
84%
80%
62%78%62%
54%
22%
11% 11%
79%
2005-09 (n= 38)
92%
79%
67%
100%
24
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 26
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Section 4G r a f t O u t c o m e
Section 4
SECTION 4 : GRAFT OUTCOME
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
25.
Graft Survival - All Grafts
SECTION 4 : GRAFT OUTCOME
Gra
ft S
urv
ival (
%)
Gra
ft S
urv
ival (
%)
1y 3y 5y 10y 15y 25y
No at risk 3400 2770 2276 1326 667 12
Actuarial Survival (%)
85% 79% 76% 67% 60% 41%
N = 4302
100
90
80
70
60
50
40
30
20
10
0
Time Post-transplant (years)
100
90
80
70
60
50
40
30
20
10
0
Graft Survival by Age Group
81%
85%
76%
74%
69%
66%
67%
58%
61%
52%
36%
Adult (n=3490)
Children (n=812)
Age group
P= 0.018
45%
20y
230
50%
Time Post-transplant (years)
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
26.
Graft Survival by Graft Number
SECTION 4 : GRAFT OUTCOME
Time Post-transplant (years)
Gra
ft S
urv
ival (
%)
Gra
ft S
urv
ival (
%)
Gra
ft S
urv
ival (
%)
100
90
80
70
60
50
40
30
20
10
86%
71%
73%
77%
63%
62%
68%
50%
52%
61%
50%
46%
51%
33%
41%
p <0.001
Graft Number
1st Grafts (n=3979) [92.5%]
2nd Grafts (n=299) [7.0%]
3rd Grafts (n=24) [0.5%]
All Grafts (n= 4302)
84%
64%
66%
77%
57%
55%
72%
43%
46%
71%
65%
p <0.001
Graft Number
1st Grafts (n=713) [88%]
2nd Grafts (n=85) [10.5%]
3rd Grafts (n=14) [1.5%]
Children (n= 812)
100
90
80
70
60
50
40
30
20
10
0
86%
80%
77%
77%
65%
70%
67%
70%
55%
58%
70%
p =0.001
Graft Number
1st Grafts (n=3266) [94%]
2nd Grafts (n=214) [6%]
3rd Grafts (n=10) [0.3%]
100
90
80
70
60
50
40
30
20
10
49%
46%
Adult(n= 3490)
35%
36%
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
55%
41%
29%
0
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
0
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
27.
Graft Survival by Type of Graft [Deceased Donors]
SECTION 4 : GRAFT OUTCOME
Time Post-transplant (years)
100
90
80
70
60
50
40
30
20
10
0
All Grafts (n= 4224)
Children (n= 748)
Adult(n= 3476)
Gra
ft S
urv
ival (
%)
Gra
ft S
urv
ival (
%)
Gra
ft S
urv
ival (
%)
P = NS
Type of Graft
Split (n=400)
Reduced (n=333)
Whole (n=3491)
82%
73%
86%
77%
65%
77%
66%
59%
68%59%
57%
60%
38%
59%
48%
47%
< 0.001
Type of Graft
Split (n=197)
Reduced (n=304)
Whole (n=247)
84%
74%
87%
77%
66%
81%
67%
60%
77%
58%
59%
76%
56%
68%
54%
P = NS
Type of Graft
Split (n=203)
Reduced (n=29)
Whole (n=3244)
80%
62%
86%
77%
58%
76%65%
45%
66%
45%
58%
58%
45%
58%
53%
48%
36%
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
100
90
80
70
60
50
40
30
20
10
010 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
100
90
80
70
60
50
40
30
20
10
0
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 23 24 25 2726 28
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
28.
SECTION 4 : GRAFT OUTCOME
Biliary
PNF/poor graft function
Vascular
Rejection
Recurrent HBV /HCV
Recurrent PBC/PSC/CAH:AI
Other
Indication for Retransplantation n = 322 (298 2nd grafts, 24 3rd grafts)
Age Group
Children(n= 111)
Adults(n= 211)
20%
6%7%11%
11%
12%
6%
16%
2%
31%
8%
37%
13%
8%
9%
9%
15%14%
33%
24TH
ANZLT REGISTRY
R E P O R T
34%
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
29.
SECTION 4 : GRAFT OUTCOME
Num
ber
of G
rafts
43 (13%) 52 (16%) 54 (17%) 33 (10%) 67 (21%) 44 (14%)N = 29 (9%)
Biliary
PNF/poor graft function
Vascular
Rejection
Recurrent HBV /HCV
Recurrent PBC/PSC/CAH:AI Other
0
0-7d 8d- 1m 1m- 6m 6m -1y 1y- 5y 5y-10y >10y
5
10
15
20
25
30
35
40
45
50
55
60
Indication for Retransplantation n = 322 (298 2nd grafts, 24 3rd grafts)
28(13%)
35 (17%)
41(19%)
22(10%)
39(18%)
30(14%)
N = 16(8%)
0-7d 8d- 1m 1m - 6m 6m -1y 1y - 5y 5y - 10y >10y
0
5
10
15
20
25
30
40
Children (n=111) Adults (n=211)
15 (14%)
17 (15%)
13 (12%)
11(10%)
28(25%)
14 (13%)
N = 13(12%)
0-7d 8d- 1m 1m - 6m 6m -1y 1y - 5y 5y - 10y >10y
0
5
10
15
20
25 35
30
65
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Section 5Cause of Patient Death
Section 5
SECTION 5 : CAUSE OF PATIENT DEATH
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Causes of Death
30.
SECTION 5 : CAUSE OF PATIENT DEATH
All Patients n = 1093
Operative
Respiratory
Cerebrovascular
Cardiovascular
Sepsis
Malignancy - recurrent
Malignancy - de novo
Recurrent HBV / HCV
Rejection
Other
Miscellaneous
Gastrointestinal
Graft failure
*
*
See Appendix V for details *
9%
14%4%
6%
7%
8%
2%
15%
10%
11%
8%
6%
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Causes of Death in Adultn = 952
31.
Operative
Respiratory
Cerebrovascular
Cardiovascular
Sepsis
Malignancy - recurrent
Malignancy - de novo
Recurrent HBV / HCV
Rejection
Other
Miscellaneous
Gastrointestinal Graft failure
*
*
See Appendix V for details *
Causes of Death in Childrenn =141
4%
SECTION 5 : CAUSE OF PATIENT DEATH
20%
7%2% 4%
15%
7%
4%
21%7%
10%
7%
15% 6%
6%
8%
2%
14%
11%12%
10%
5%
4%
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
32.
SECTION 5 : CAUSE OF PATIENT DEATH
Cause of Death by Time Post Transplant
Operative
Respiratory
Cerebrovascular
Cardiovascular
Sepsis
Malignancy - de novo
Malignancy - recurrent
Gastrointestinal
N = 122 (11%) 257 (24%)103 (9%) 130 (12%) 86 (8%) 199 (18%)
Recurrent HBV / HCV
Rejection
Other [graft failure]
Miscellaneous
110 (10%) 86 (8%)
*
*
See Appendix V for details *
1y - 5y 5y - 10y 10y - 15y >15y0 - 7d 8d - 1m 1m - 6m 6m - 1y
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
33.
SECTION 5 : CAUSE OF PATIENT DEATH
N = 24 (17%) 27 (19%)23 (16%) 25 (18%) 9 (6%) 16 (11%) 6 (4%) 11 (8%)
Cause of Death by Time Post Transplant Children (n=141)
Operative
Respiratory
Cerebrovascular
Cardiovascular
Sepsis
Malignancy - de novo
Malignancy - recurrent
Gastrointestinal Recurrent HBV / HCV
Rejection
Other [graft failure]
Miscellaneous
N = 98 (10%) 230 (24%)80 (8%) 105 (11%) 77 (8%) 183 (19%) 104 (11%) 75 (8%)
1y - 5y 5y - 10y 10y - 15y >15y0 - 7d 8d - 1m 1m - 6m 6m - 1y
Cause of Death by Time Post Transplant Adult (n=952)
1y - 5y 5y - 10y 10y - 15y >15y0 - 7d 8d - 1m 1m - 6m 6m - 1y
0%
20%
40%
60%
80%
100%
0%
20%
40%
60%
80%
100%
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Section 6Deceased Donor Information
Section 6
SECTION 6 : DECEASED DONOR INFORMATION
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
0
50
100
150
200
250
300
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
0
50
100
150
200
250
300
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Grafts from deceased donors
34.
Deceased Donation by Year
Cadaveric donors Grafts transplanted
Num
ber
Year
Waiting list - 31 Dec
SECTION 6 : DECEASED DONOR INFORMATION
DCD donors*
QLD NSW/ACT VIC/TAS SA/NT WA NZ TOTAL 2003 34 32/3 29/2 13 15 31 159
2004 30 49/4 35/1 26/1 17 35 198
2005 24 36/8 38/2 17/3 25 21 174
2006 28 34/3 39/6 25 17 24 176
2007 25 36/1 36 19/2 15 32 166
2008 33 40/3 41/5 31/1 25 23 203
2009 35 46/4 36/5 28/2 15 33 204
2010 30 55/8 53/6 18/2 17 32 221
2011 44 52/7 49/3 22/2 20 30 229
2012 46 50/7 52/10 21/6 20 28 240
3 1351* 4 13 17
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
35.
Time Post-transplant (years)
Gra
ft S
urv
ival (
%)
Donor
age (
years
)
Era
SECTION 6 : DECEASED DONOR INFORMATION
1985 - 1989
80
70
60
50
40
30
20
10
0
1990 - 1994 1995 - 1999 2000 - 2004 2005 - 2009
Donor Age by EraN = 3899
Graft Survival by Donor AgeN = 4097
2010 - 2012
100
90
80
70
60
50
40
30
20
10
0
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 22 24
P <0.001
Donor age group
>65y
0.01-10y11-30y31-50y51-60y61-65y
n= 213
n= 192n= 1403n= 1445n= 639n= 205
n = 96 593 728 869 923
28.6y
36.4y40.0y
43.9y 45.2y
N = 3899Median Age: 39.2yRange: 3d - 84.3y
P < 0.001
690
20.3y
23 25
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Section 7L i v i n g D o n o r T r a n s p l a n t a t i o n
Section 7
SECTION 7 : LIVING DONOR TRANSPLANTATION
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
36.
Living Donor TransplantationN = 70
SECTION 7 : LIVING DONOR TRANSPLANTATION
Surv
ival (
%)
Time Post-transplant (years)
Donor age
Median
Range
Mother
Father
Son
Daughter
Grandmother
Grandfather
Sister
Brother
Aunt
Family friend
Cousin
Spouse
Donor gender
Male
Female
Child [n=63] Adult [n=14]
-
34.7y
20.1 - 54.5y
-
15
31
-
-
1
1
-
2
6
5
2
-
-
30.3y
22.8 - 44.2y
-
-
-
4
1
-
-
3
3
-
1
-
1
-
38
25
-
9
5
All [n=77]
-
33.8y
20.1 - 54.5y
-
15
31
4
1
1
1
3
5
6
6
2
1
-
47
30
Recipient Age Group
*
* 1 x whole liver domino transplant
90
80
70
60
50
40
30
20
10
0
10 2 3 4 5 76 8 9 10 11 1312 14 15 16 17 1918 20 21 23
100
(71 patients received LD graft as first graft)Patient
Graft o nd rd(All grafts n= 77 [71 x 1 , 5 x 2 , 1 x, 3 ])
Donor relationship
22
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Section 8W a i t i n g L i s t
Section 8
SECTION 8 : WAITING LIST
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Waiting List Activity[ Data 1/1/08 - 31/12/12]
37.
SECTION 8 : WAITING LIST
Outcome of Initial Urgent Listing
[* Patient decline, Malignancy, Drug Use, Infection, Further investigations, Medical]
TRANSPLANTED
IMPROVED
DIED / TOO SICK
OTHER TREATMENT
2008
(n=13)
3 9
3 2
2009
(n=17)
7 6
- -
2010
(n=19)
13
1
5
-
OUTCOME
}46% }65% }74%
2011
(n=15)
12
-
3
-
}80%11
2
3
-
}81%
Listed at 1 January
New listings
Transplant
Activity
Still listed at 31 Dec
OUTCOME
TOTAL
Died on list
Too sick
Tumour progression
Improved
Other
TOTAL 2012
539
Delisted
Adult
121 [26%]
160
464
28
14
10
15
16
Paediatric
47 [63%]
22
75
1
2
-
2
1
2012
83 [18%] 6 [8%]
268 [50%]
182 [34%]
89 [16%]
}[10%]29
17
1610
17
199
290
229 [47%]
169 [34%]
489
48
14
7
15
11
2008
}14%
96 [20%]
*
9
1
3
-
OUTCOME
175
335
248 [49%]
194 [38%]
510
12
12
12
16
12
2010
}8%
68 [13%]
169
335
228 [46%]
175 [34%]
504
32
17
8
18
26
2009
}14%
101 [20%]
*
2
1
-
-
1 active
31/12/11
24TH
ANZLT REGISTRY
R E P O R T
194
336
253 [49%]
192 [36%]
530
17
17
20
12
19
2011
}8%
85 [13%]
*
192
-
106
45
192
11
8
5
9
8
-
347
162
137
347
18
8
5
8
9
41 48
}11% }4%
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
2012
CATEGORY 1
N=16 Adultn=13
Paediatricn=3
TRANSPLANTED
IMPROVED
DIED / TOO SICK
OTHER TREATMENT
2008
(n=24)
20 18
1 1
2009
(n=21)
3 2
- -
2010
(n=30)
23
5
1 / 1
-
OUTCOME
}83% }90% }93%
2011
(n=28)
22
2
3
}86%14
3
1
}89%8
1
1
-
6
2
-
2012
CATEGORY 2
N=19 Adultn=10
Paediatricn=9
1 active
31/12/12
1 active
31/12/12
Outcome by Blood Group
Waiting Time to Transplant 2012
A O B AB TOTAL
n=
Not transplanted
Transplanted
210 (39%) 234 (43%) 67 (12%) 27 (5%) 539
Blood Group
101 125 33 11 271
109 (52%) 109 (47%) 34 (51%) 16 (59%) 268
*
**
* % of total number listed
** % of blood group
38.
SECTION 8 : WAITING LIST
Blood Type
OBABA
Waiti
ng T
ime (
Month
s)
6
4
2
0
16
14
12
8
10
26
24
22
18
20
36
34
32
28
30
38
-2
69d95d 116d119dMedian
n= 109 (41%) 109 (41%)34 (13%) 16 (6%)
P= NS
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Waiting Time by Outcome
39.
SECTION 8 : WAITING LIST
Waiti
ng T
ime (
Month
s)
Patient Outcome
Waiting Time by Outcome & Blood Group
Waiti
ng T
ime (
Month
s)
Blood Type
Listed 2012Waiting
Listed 2012TransplantListed 2012
DelistedListed pre '12
Waiting
Listed pre '12
TransplantListed pre '12
Delisted
9
6
3
0
21
18
12
15
33
30
24
27
45
42
36
39
54
48
51
642
0
16
14
12
8
10
26
2422
1820
3634
32
2830
38
-3
57
-2
63
60
69
66
48
4644
4042
AB B OA
5052
54565860
24TH
ANZLT REGISTRY
R E P O R T
Median 296d 275d
46d 36d96d
627d
Median waiting time to transplant= 110d (0-73m)
Median waiting time listed patients 31/12/12
= 159d (1d-72m)
72
Median= 117d 45d 107d 154d
Transplanted
Not transplanted
Patient Outcome
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Section 9L i v e r T r a n s p l a n t a t i o n a n d C a n c e r
Section 9
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Cancer in Liver Transplant Recipientsn = 3980
40.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
Liver Cancer as Primary Diagnosisn= 3980
24TH
ANZLT REGISTRY
R E P O R T
At Tx
Liver Cancer as Primary Diagnosis 295 (7%)
Liver Ca as a Secondary Diagnosis 471 (12%) 473 Ca
Total 766 (18%)
Post Tx
Recurrent Liver Ca 113(3% of all pts, 16% of pts with Ca at Tx)
De Novo Ca 295 (7%) 309 Ca
Skin Ca 984 (25%) 3809 Ca
Total 1392 (35%)
Multiple Ca 555
Pre-Tx cancer developed de novo cancer 25 (3% of pts with Ca at Tx)
Transferred from Donor 2
Developed non skin Ca < 90days 9
n = 3980
TYPE OF CA No DIEDDIED OF THIS
CA
HEPATOCELLULAR CA 259 64 34 (36%)
HEPATOBLASTOMA 19 5 4 (67%)
FIBROLAMELLAR 6 5 2 (40%)
CARCINOID 4 4 4 (100%)
CHOLANGIOCARCINOMA 2 1 1 (50%)
ANGIOSARCOMA 1 1 1 (100%)
EPITHELOID HAEMANGIOENDOTHELIOMA 2 0 0
GASTRINOMA 1 1 1 (100%)
PANCREATIC ISLET CELL 1 1 1 (100%)
TOTALS 295 (7% of pts)82 (28% of
those with PCa)
48 (16% of those with
PCa)
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Overall SurvivalPrimary Liver Cancern = 295 (7% of patients transplanted)
41.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
Overall SurvivalPrimary Liver Cancern =295/3980 (7%)
24TH
ANZLT REGISTRY
R E P O R T
0
20
40
60
80
100
0 5 10 15 20
Years Post Tx
%S
urv
ivin
g
n = 295 (7% of pts transplanted)
5y 10y 15y
No at risk 95 28 9
Actuarial Survival % 70 57 49
0
20
40
60
80
100
0 5 10 15 20
Years post Tx
HCC(n=259)
Other(n=9)
Fibromellar(n=6)
Hepatoblastoma (n=19)
CC(n=3)
%S
urv
ivin
g
p<0.05
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Primary Liver Cancer Actuarial Survival Summaryn = 3980
42.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
Liver Cancer as Primary Diagnosisn = 295
24TH
ANZLT REGISTRY
R E P O R T
1yr 5yr 10yr 15yr
HCC (n=259)n 217 84 22 6
% 91 72 60 60
Other (n=9)n 9 4 2 2
% 89 44 15 15
Hepatoblastoma(n=19)n 18 6 3 2
% 95 75 50 50
Fibrolamellar (n=6)n 6 4 4 2
% 83 63 63 21
CC (n=3)n 23
% 50
9
2
18
43
67
120
8
1811 10
18 17
0
20
40
60
80
100
120
140
1985 - 1989 1990 - 1994 1995 - 1999 2000 - 2004 2005-2008 2009-2012
HCC(n=259)
Other (n=83)
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Liver Cancer as a Secondary Diagnosisn = 3980
43.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
Primary Liver Cancer Incidence and Mortality
* 1 patient had 2 secondary cancers
24TH
ANZLT REGISTRY
R E P O R T
0
5
10
15
20
25
30
35
40
45
50
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Primary Malignancy(n=295)
Mortality (n=153)
No DiedDied of This
Cancer
HEPATOCELLULAR CA* 426 122 33 (27%)
CHOLANGIO CA 34 25 13(52%)
HEPATOBLASTOMA* 3 1 0
LAMELLA VARIANT 4 2 0
OTHER 6 4 2 (50%)
Total473* in 471pts (12%)
152 (32% of pts with SCa)
48 (10% of pts with SCa)
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Overall SurvivalLiver Cancer as a Secondary Diagnosis
44.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
Liver Cancer as a Secondary Diagnosisn = 3980
24TH
ANZLT REGISTRY
R E P O R T
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years Post Tx
n=471/3980 (12%)
5y 10y 15y
No at risk 207 86 18
Actuarial Survival % 72 62 42
%S
urv
ivin
g
0
20
40
60
80
100
0 2 4 6 8 10 12 14 16 18
% Surviving
Years Post Tx
Lamella Variant (n=4)
Hepatoblastoma=3
HCC(n=426)
CC(n=34)
Other(n=6)
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
45.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
Secondary Liver Cancer Actuarial Survival Summaryn =473/ 3980 (12%)
Liver Cancer as a Secondary DiagnosisIncidence and Mortalityn=473/3890 (12%)
24TH
ANZLT REGISTRY
R E P O R T
1yr 5yr 10yr 15yr
HCC (n=385)n 305 178 65 7
% 79 46 17 2
CC (n=33)n 27 10 5 2
% 82 30 15 6
Hepatoblastoma (n=3)n 3 2 2 1
% 100 67 67 33
Fibrolamellar (n=4)n 4 4 2 2
% 100 100 50 50
Other (n=7)n 7 4 1 0
% 100 57 14 0
0
5
10
15
20
25
30
35
40
45
50
19
85
19
86
19
87
19
88
19
89
19
90
199
1
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
200
1
200
2
20
03
20
04
20
05
20
06
200
7
20
08
20
09
20
10
20
11
201
2
Secondary Malignancy (n=473)
Mortality (n=157)
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Liver Cancer (Primary or Secondary Diagnosis) n = 3980
46.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
Patient Actuarial SurvivalBenign Disease vs Pre Transplant Liver Malignancyn = 3980
* 1 patient had 2 secondary cancers
24TH
ANZLT REGISTRY
R E P O R T
TYPE OF CA NO DIED DIED OF THIS CA
HEPATOCELLULAR CA* 685 188 67 (41%)
CHOLANGIOCARCINOMA 36 27 15 (53%)
HEPATOBLASTOMA* 22 6 4 (66%)
FIBROLAMELLAR 10 5 2 (40%)
CARCINOID 4 4 4 (100%)
ADENOCARCINOMA 4 3 1 ((20%)
EPITHELOID HAEMANGIOENDOTHELIOMA 3 0 0
GASTRINOMA 1 1 1 (100%)
PANCREATIC ISLET CELL 1 1 1 (100%)
ANGIOSARCOMA 2 2 2 (100%)
TOTALS768 (19% of
pts)237 (31%of
those with Ca)97 (13% of those with Ca
at Tx)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Years Post Tx
% Surviving
Benign disease (n=3212)
Malignant Disease (n=768)
p=0.000
5y 10yr 15yr 20yr
Benign Disease
n 1960 1236 655 237
% Surviving 83 74 67 56
Malignant Disease
n 301 113 26 6
% Surviving 71 60 44 28
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
47.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
De Novo Non Skin CancerNo at Risk = n = 3980
Time to 1st De Novo Non Skin Cancern = 3980309 cancers in 295 pts (7% of all pts)
24TH
ANZLT REGISTRY
R E P O R T
Fifteen patients also had a liver cancer at Tx; * 11 patients had more than 1 de novo malignancy
No MaleFemal
e Age of pts (yrs)Time to diagnosis
(mths)Died of This
Cancer
Alimentary* 114 83 31 13 – 78 (m 57) 3 – 232 (m 107) 52 (46%)
Lymphoma* 79 49 30 1– 70 (m 49) 1 – 214 (m 64) 28 (35%)
Genitourinary* 39 26 13 21 – 75 (m 60) 2 – 231 (m 87) 4(10%)
Breast 23 - 23 30 – 74 (m 53) 11 –241(m 112) 9 (39%)
Respiratory 26 21 5 29 – 75(m 58) 7 – 212(m70) 19(73%)
Kaposi’s 5 4 1 32 – 65 (m 51) 2 – 48 (m 21) 0
Endocrine 9 4 5 36 – 70 (m 55) 35 – 213 (m89) 3 (33%)
CNS 7 5 2 16 – 75 (m 57) 14 –211(m118) 6(86%)
Leukaemia 3 1 2 3.– 50 (m 30) 16 – 44 (m 30) 0
Miscellaneous 4 2 2 62 – 73 (m 65) 6 – 234 (m 75) 1 (25%)
Total*309ca in
295pts 195 114 1 – 78 (m 53) 1 – 242 (m 72)122 (41% of pts with Ca)
0
5
10
15
20
25
30
0-3m 3-12m 1-3yr 3-5yr 5-10y >10y
Alimentary Tract
Breast
CNS
Endocrine
Genitourinary
Kaposi's sarcoma
Leukaemia
Lymphoma
Miscellaneous
Respiratory
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
48.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
De Novo Non Skin Cancern = 309/3980(8%)
De Novo Non Skin Cancer vs All Patientsn = 3980
24TH
ANZLT REGISTRY
R E P O R T
0
20
40
60
80
100
0 5 10 15 20 25
Years Post Tx
% Surviving
All pts.(n=3685)
De Novo(n=295)
p<0.0001
5y 10yr 15yr 20yr
Othersn 2058 1216 611 220
% Surviving 81 74 67 58
De Novon 204 133 70 23
% Surviving 76 58 43 25
Breast, 23. 7%
CNS, 7, 2%Endocrine, 9.3%
Genitourinary, 39, 13%
Kaposi's, 5, 2%
Leukaemia, 3, 1%
Lymphoma, 79. 26%
Miscellaneous, 4. 1%
Respiratory, 26, 8%
Upper GI, 23%
Lower GI, 69 %
Pancreas, 8, 8%
Alimentary,114 37%
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
49.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
De Novo Non Skin CancerAlimentary Tract Incidencen = 114/309 cancers (37%)
Pre Transplant Liver Disease andDe Novo Non Skin Cancer n = 309/3980 (7%)
24TH
ANZLT REGISTRY
R E P O R T
59
11 11
25
8
0
10
20
30
40
50
60
70
Colorectal Liver Stomach Upper GI Pancreas
21
4
35
6
1 1
Lymphom
a
Breast
Alimentary
Genitourinary
Kaposi's
Leukaemia
1
10
1 1
Lymphom
a
Alimentary
Genitourinary
Respiratory
PSC + Auto-immune - 73/309 24% of all de novo
HBV - 13/3094% of all de novo
p=nsP<0.0001
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
50.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
Pre Transplant Liver Disease andDe Novo Non Skin Cancer n = 309/3980 (7%)
Primary Liver Disease andDe Novo Non Skin Cancern = 309/3980 (7%)
24TH
ANZLT REGISTRY
R E P O R T
13
22
86
1 1 1
Lym
ph
om
a
Alim
en
tary
Re
spira
tory
Ge
nito
urin
ary
Ka
po
si's
Le
uka
em
ia
CN
S
HCV - 57/30918% of all de novo
20
5
7
4
21
Alim
en
tary
Lym
ph
om
a
Re
spira
tory
Ge
nito
urin
ary
CN
S
Oth
er
Alcohol –39/30913% of all de novo
0
10
20
30
40
50
60
PS
C
Alco
hol
HC
V
PB
C
Pre
Tx C
ance
r
Auto
imm
une
HB
V
Meta
bolic
Fulm
inant
Bilia
ry Atre
sia
Oth
er
HC
V_H
BV
Respiratory
Other
Lymphoma
Leukaemia
Kaposi's sarcoma
Genitourinary
Endocrine
CNS
Breast
Alimentary Tract
PSC p<0.0001
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
51.
SECTION 9 : LIVER TRANSPLANTATION AND CANCER
Skin Ca Post Ltxn = 3980
**555 pts had multiple skin cancer types
Time to Melanoma Skin Cancer Developmentn = 29(0.7% of all pts)
Cumulative Risk of Diagnosis of Cancer Following Liver Tx. 1985-2012
24TH
ANZLT REGISTRY
R E P O R T
Type of Skin Cancer
Pts Cancers
BCC 333 1071
SCC 364 1532
Melanoma 29 29
Total 948 (26% of all pts)** 3809
n =3980
1
8
12
7
3-12m 1-5yrs 5-10yrs >10yrs
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Patients at Risk (3980)
Years Post Tx
Any CaSkinNon skin (includes recurrent primary and secondary liver cancer)De Novo Non skinAge-Matched Gen. Pop
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Appendix IAppendix I
APPENDIX
Liver Transplant Units of Australia and New Zealand
South Australian Liver Transplant Unit
Flinders Medical Centre
Flinders Drive
BEDFORD PARK SA 5042
http://www.flinders.sa.gov.au/flinders_centre_for_digestive_health/
WA Liver Transplantation Service
Sir Charles Gardiner Hospital
Verdun Street
NEDLANDS WA 6009
New Zealand Liver Transplant Unit
Auckland City Hospital
Park Road
Auckland
New Zealand
Http://www.nzliver.org/
The Children's Hospital at Westmead
Hawkesbury Road
WESTMEAD NSW 2145
The Royal Children's Hospital
Flemington Road
PARKVILLE VIC 3052
The Royal Children's Hospital
Bowen Bridge Road
HERSTON QLD 4029
Australian National Liver Transplant Unit
Royal Prince Alfred Hospital
Missenden Road
CAMPERDOWN NSW 2050
Email: [email protected]
http://www.sswahs.nsw.gov.au/Gastro/LiverTransplant/default.htm
Victorian Liver Transplantation Unit
The Austin Hospital
Studley Road
HEIDELBERG VIC 3084
http://www.austin.org.au/Content.aspx?topicID=397
Queensland Liver Transplant Service
Princess Alexandra Hospital
Ipswich Road
WOOLLOONGABBA QLD 4102
and
and
and
52.
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Appendix IIAppendix II
APPENDIX
53.
ANZLTR PRIMARY Diagnosis Metabolic disorders by Age Group
-1 Antitrypsin deficiency
Crigler-Najjar
Familial amyloid polyneuropathy
Glycogen storage disease
Haemochromatosis
Homozygous Hypercholesterolemia
Idiopathic copper toxicosis
Indian childhood cirrhosis Other
Primary hyperoxaluria
Tyrosinemia Urea cycle disorders Wilsons disease
Total
Bile acid synthesis disorder Protein C deficiencyMethylmalonic acidemiaFamilial immunodeficiencyMitochondrial diseaseAmyloidosisMaple syrup urine diseasePorphyriaPropionic acidemia
36
9
0
2
3
5
1
1
9
7
4
18
8
103
48
1
31
3
28
2
0
0
5
6
0
4
28
156
Age group
Primary Diagnosis
84
10
31
5
31
7
1
1
14
13
4
22
36
259
*
**
OTC deficiency 13Citrullinemia 4Argininosuccinic aciduria 4Carbamyl phosphate synthetase deficiency
* **
Child Adult
Total
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Appendix IIIAppendix III
APPENDIX
54.
ANZLTR PRIMARY Diagnosis - Other by Age Group
Coach syndromeBiliary sclerosisCornelia De Lange SyndromeHepatic Lymphangiomatosis
Alagille syndrome
Alagille non-syndromic
Benign liver tumour - Adenomatosis
Benign liver tumour - Hemangioma
Caroli's disease / congenital hepatic fibrosis
Choledocal cyst
Cholestatic disease-Other
Chronic Budd Chiari
Congenital biliary fibrosis
Ductopenia
Granulomatous hepatitis / sarcoidosis
Histiocytosis X
Liver Trauma
Neonatal hepatitis
Nodular regenerative hyperplasia
Non alcoholic fatty liver (NAFLD or NASH)
Polycystic Liver disease
Polycystic liver and kidney disease
Progressive familial intrahepatic cholestasis(PFIC)
Secondary biliary cirrhosis
Secondary biliary cirrhosis - Hepatolithiasis
Secondary biliary cirrhosis - Cystic fibrosis
Other - specify
Total
24
2
0
0
3
2
1
1
0
1
0
4
0
4
0
0
0
0
20
2
0
11
8
83
6
0
2
2
19
2
7
30
2
3
4
0
1
0
7
81
19
9
5
12
4
17
22
254
30
2
2
2
22
4
8
31
2
4
4
4
1
4
7
81
19
9
25
14
4
28
30
337
Primary DiagnosisAge group
#
Child Adult
Total
# Vanishing bile duct syndrome Haemangiotelangiectasia Veno-occlusive disease Chronic Active Hepatitis A Non-cirrhotic portal hypertension Kassabach-Merritt syndrome Arterial-venous malformation Hereditary haemorrhagic telengectasia / OWRD Oriental cholangio hepatitis
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Appendix IVAppendix IV
APPENDIX
55.
ANZLTR PRIMARY Diagnosis Fulminant Hepatic Failure by Age Group
Acute - Budd Chiari
Acute - Wilson's
Acute - -1 -AAT
Acute Autoimmune hepatitis
Acute Unknown / unspecified
Acute - Paracetamol
Acute - Other drugs
Acute Herbs / mushrooms
Acute - Hepatitis A
Acute - Hepatitis B
Acute - Non A-E
Acute - Hepatitis E
Acute - Post liver resection
Subacute - Budd Chiari
Subacute - Wilson's
Subacute Autoimmune hepatitis
Subacute - Drug / Herbs
Subacute - Unknown / unspecified
Subacute - Hepatitis A
Subacute - Hepatitis B
Subacute - NonA - NonB
Total
0
7
2
0
43
3
3
0
0
0
6
0
1
1
2
1
1
5
0
0
0
75
2
16
0
6
89
15
21
6
3
56
15
1
1
2
4
14
10
31
2
16
1
311
2
23
2
6
132
18
24
6
3
56
21
1
2
3
6
15
11
36
2
16
1
386
Primary Diagnosis
Children Adult
TotalAge group
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012
Appendix VAppendix V
APPENDIX
56.
ANZLTR Causes of Patient death
Non thrombotic infarction
Primary non function
Massive haemorrhagic necrosis
Recurrent disease (ALD, PSC, CAH:AI)
De novo Hep C
Biliary Complications
Other (PNC, immune hepatitis, outflow obstruction)
7
14
21
Graft failure - other
Children Adult
TotalAge group
Hepatic artery
Portal vein
Hepatic vein
Vascular thrombosis
4
2
1
8
6
-
12
8
1
17
Renal Failure
Graft vs Host disease
Social
Sudden death (cause unknown)
Other (Hyperkalaemia,motor neurone disease diabetes complications, drug reaction, progression FAPessential thrombocythemia)
5
48
53
Miscellaneous Children Adult
Multiorgan failure
(accident, suicide,non-compliance, Rx withdrawn)
1 29
30
-
7
7
1
14
15
1
23
24
2
20
22
-
2
3
11
7
8
2
14
15
28
69
97
TOTAL
10
141
151
TOTAL
-
17
0
17
3
4
4
-
3
21
4
24TH
ANZLT REGISTRY
R E P O R T
DATA TO 31/12/2012 © copyright ANZLTR Data to 31.12.2012