Australia and New Zealand (ANZ) are considered to be the same region for the purpose of organ allocation and data collection in the context of Liver Transplantation although funding and oversight of individual programmes remains the duty of separate state and national governments.

Between Jan 1985 and Jan 2013, 4302 orthotopic liver transplants (OLT) were performed in ANZ on 3980 patients. There were 3266 adult patients (82%) and 714 (18%) children.

In contrast to regions elsewhere in the world, the predominant source of organ donation comes from brain dead deceased donation rather than from living donors. A small but growing number of DCD donors have contributed over the last few years. An agreed priority allocation system operates between centres for urgent patients based on Kings College criteria. Allocation within individual jurisdictions largely follows MELD score. Liver splitting occurs in most centres and partial grafts are shared between programmes. Split grafts provide approximately 24% of all paediatric transplants, 45% are from other reduced size grafts including only 63 from living donors. In adult patients 245 have received reduced size grafts, 203 from splits, 29 others from reduced sized cadaveric donors and 13 from living donors.

Similar listing criteria are followed in each centre. As a result the annual waiting list mortality using “an intent to treat” basis has not exceeded 15% for adults in the last decade and it is currently <4% for children. The number of patients listed for transplantation increased slightly in 2012 and 182 patients remained on the waiting list at January 1 2013. 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 Category 1 and 19 Category 2]. Thirteen [81%] of Category 1 and 17 [89%] of Category 2 patients had a positive outcome.

Potential organ donors are voluntarily registered on a national data base in Australia and this data is accessible at any hour by local donor co-ordinators. A national authority has been set up to oversee policy and performance in relation to organ and tissue donation.

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. Nine hundred and forty eight patients (25%) developed 3809 skin cancers with 555 patients having multiple skin cancer types and 29 had melanoma. The cumulative risk of developing cancer of any description post transplant is approaching 40% by 20 years.

Data provided is from the Australian and New Zealand Liver Transplant Registry’s 24th annual edition which compiles and analyses the key cumulative data on every liver transplant performed in both countries since the establishment of the first liver transplant unit in the region in 1985. On-line real time data entry is via secure connection. Data is de-identified centrally and outcome comparisons are available for individual programmes versus all centres as a whole. Comparison of one centre against another is not available. Data is audited and checked for accuracy and duplication.