Liver transplantations in the Nordic countries, 1982-1998: Changes of indications and improving results

Background: Liver transplantation has become an established therapeutic opt ion for patients with life-threatening liver disease. The aim of the presen t study was to analyse the results of and developments in liver transplanta tion in the Nordic countries during a 15-year period. Methods: Data on all patients receiving a liver allograft in the Nordic countries during 1982-98 and waiting list data for all patients listed for a liver transplantation after 1989 were obtained from the Nordic Liver Transplantation Registry. Re sults: A total of 1485 first liver transplantations were performed during 1 982-98. The annual number of first liver transplantations increased steadil y up to 1993, thereafter remaining around 150-170 per year. There are major differences between countries both in the number of transplants adjusted t o populations performed per year, with more than twice as many performed in Sweden as in Norway, and in the relative distribution of patients in accor dance with diagnosis. The number of patients more than 60 years old increas ed and comprised 13%-14% of the total patient population during 1996-98. Pr imary biliary cirrhosis, primary sclerosing cholangitis, acute hepatic fail ure, malignant liver disease, and alcoholic cirrhosis are the five most fre quent diagnoses. The over-all 1-year patient survival probability has incre ased from 66% among patients receiving a transplant in 1982-89 to 83% in 19 95-1998. The waiting time remains stable, with a median waiting time of 35 days during 1990-98. The mortality of patients while on the waiting list is 7.4% and is not increasing. Conclusion: Results of liver transplantation i n the Nordic countries are very similar to those obtained in other countrie s. Waiting time and mortality remain low. There are, however, major differe nces between the countries both as to the number of transplantations perfor med and as to distribution of diagnoses.