OPTN/SRTR 2023 Annual Data Report: Liver

The number of liver transplants performed in 2023 in the United States reached another record high, totaling 10,659 overall, of which 10,125 (95.0%) were in adult recipients and 534 (5.0%) were in pediatric recipients. This growth was driven by increased recovery of livers from older donors and donation after circulatory death (DCD) donors—likely related to the wider availability of machine perfusion technologies. The overall nonuse rate, or percent of livers recovered for transplant and not transplanted, was 9.7%, a decrease from the preceding years, and 16.7% of transplant recipients accepted DCD livers. There was also growth in living donation, representing 5.7% of adult transplants and 14.6% of pediatric transplants. In July 2023, the model for end-stage liver disease (MELD) 3.0 and pediatric end-stage liver disease (PELD)–creatinine scoring systems were updated from MELD-sodium and PELD, respectively, and criteria for status 1B qualification for pediatric candidates were updated. A major goal of MELD 3.0 was to address the sex disparity in deceased donor transplant rates. In 2023, the gap in deceased donor liver transplant rates between sexes narrowed, although the rate remained higher for adult male candidates compared with female candidates, and pretransplant mortality rates were higher among adult female candidates compared with male candidates. Alcohol-associated liver disease and metabolic dysfunction–associated steatohepatitis remained the leading indications for liver transplant.