Liver Transplantations in the Nordic Countries, 1982–1998: Changes of Indications and Improving Results K. Bjøro, S. Friman, K. Ho ¨ckerstedt, P. Kirkegaard, S. Keiding, E. Schrumpf, M. Olausson, A. Oksanen, H. Isoniemi, A. Hjortrup, A. Bergan & B. G. Ericzon Dept. of Medicine A and Dept. of Surgery B, Rikshospitalet, Oslo, Norway; Dept. of Transplantation Surgery, Sahlgrenska Hospital, Go ¨teborg, and Division of Gastroenterology and Hepatology and Dept. of Transplantation Surgery, Huddinge Hospital, Stockholm, Sweden; Dept. of Surgery, University Hospital, Helsinki, Finland; and Dept. of Transplantation Surgery, Rigshospitalet, Copenhagen, and PET Centre and Dept. of Medicine, Aarhus University Hospital, Aarhus, Denmark Bjøro K, Friman S, Ho ¨ckerstedt K, Kirkegaard P, Keiding S, Schrumpf E, Olausson M, Oksanen A, Isoniemi H, Hjortrup A, Bergan A, Ericzon BG. Liver transplantations in the Nordic countries, 1982– 1998: changes of indications and improving results. Scand J Gastroenterol 1999;34:714–722. Background: Liver transplantation has become an established therapeutic option for patients with life- threatening liver disease. The aim of the present study was to analyse the results of and developments in liver transplantation 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. Results: A total of 1485 first liver transplantations were performed during 1982–98. The annual number of first liver transplantations increased steadily up to 1993, thereafter remaining around 150–170 per year. There are major differences between countries both in the number of transplants adjusted to populations performed per year, with more than twice as many performed in Sweden as in Norway, and in the relative distribution of patients in accordance with diagnosis. The number of patients more than 60 years old increased and comprised 13%–14% of the total patient population during 1996–98. Primary biliary cirrhosis, primary sclerosing cholangitis, acute hepatic failure, malignant liver disease, and alcoholic cirrhosis are the five most frequent diagnoses. The over-all 1-year patient survival probability has increased from 66% among patients receiving a transplant in 1982–89 to 83% in 1995–1998. 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 in the Nordic countries are very similar to those obtained in other countries. Waiting time and mortality remain low. There are, however, major differences between the countries both as to the number of transplantations performed and as to distribution of diagnoses. Key words: Hepatitis B virus; hepatitis C virus; liver transplantation; primary biliary cirrhosis; primary sclerosing cholangitis Kristian Bjøro, M.D., Ph.D., Dept. of Medicine, Rikshospitalet, The National Hospital, N-0027 Oslo, Norway (fax. 47 22868091) L iver transplantation has become an established ther- apeutic option for patients with both acute and chronic terminal liver failure (1, 2). The activity has increased considerably during the past 15 years, and this therapy is now offered routinely to selected patients with advanced liver failure in all developing countries. The prevalence of chronic liver disorders leading to terminal liver failure varies considerably in different coun- tries (3–10). This may at least to some extent explain the observed differences in the numbers of liver transplantations performed in various countries (11, 12). We here present the total activity of liver transplantations in the five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) during the period 1982 throughout 1998. The study is based on a Nordic liver transplantation registry comprising data on all patients from acceptance on the waiting list and including the history of their liver disease. Data on outcome after listing, such as deaths and perma- nent withdrawals from the waiting list, are thus available. The registry has been an essential factor for a close collabo- ration between all liver transplant centres in the Nordic countries. Materials and Methods Patients All patients listed for a liver transplantation in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) after 1 January 1990 have been recorded prospectively in the Nordic Liver Transplant Registry (NLTR). From 1995 the ORIGINAL ARTICLE © Scandinavian University Press 1999 Scand J Gastroenterol Downloaded from informahealthcare.com by Goteborgs University on 06/17/12 For personal use only.