Liver transplant volumes increase 30 percent year over year

Baylor University Medical Center (Baylor Dallas), part of Baylor Scott & White Health, performed 114 liver transplants in 2024, a 30-percent increase over the previous year. This number represents the most liver transplants performed in seven years. In fiscal year 2025 (July 1, 2024 – June 30, 2025), the program grew even more with 130 liver transplants performed. In addition, the latest SRTR data show 90-day graft survival is significantly higher than the national average.

According to Amar Gupta, MD, FACS, FRCS(C), Surgical Director of Liver Transplantation, Baylor Dallas, the reasons behind the increase and excellent outcomes are multifactorial. These factors include a wide range of innovative approaches, including living donor liver transplant, the safe use of organs that may have not been considered in the past and new donor organ preservation technologies.

"We have had an increase in the number of patients undergoing liver transplant evaluation with a spectrum of disease severity, ranging from outpatients whose liver disease is starting to worsen to critically ill patients in the ICU,” Saleh Elwir, MD, Medical Director of Liver Transplantation, Baylor Dallas, says. “The expanding use of innovative technologies and living donor transplant has allowed more patients access to liver transplant that in the past would have to be much sicker before getting a transplant under the current liver transplant allocation system.”

In addition, Baylor Dallas has established a pathway for patients whose liver disease is caused by alcohol use. This pathway provides them with the tools and resources they need to deal with the alcohol use and subsequently be candidates for liver transplantation.

“This program has allowed us to expand on both fronts,” Dr. Gupta says, “in evaluating and transplanting more patients, but doing so in a responsible way that decreases recidivism and improves outcomes. Through this program, we try to set patients up for success by giving them the tools they need before transplant, rather than being reactive after transplant.”

Although the use of organs after circulatory death (DCD) is yet to be accepted universally, Baylor Dallas sits in the upper echelon of transplant programs performing DCD liver transplants. Since Jan. 1, 2024, the Baylor Dallas transplant team has performed 188 liver transplants. Of those, 53 percent came from DCD donors. At that time, the national rate of DCD liver transplants was 20 percent. Through the use of organ preservation technologies, that number rose to 38 percent nationwide. Yet, Baylor Dallas remains 15 percent even higher than that.

The transplant team at Baylor Dallas successfully uses DCD organs through the use of two advanced organ preservation technologies. Normothermic regional perfusion (NRP), which utilizes extracorporeal membrane oxygenation technology, allows for in situ perfusion of the liver. This technique, which is exclusively used for DCD organs, effectively reperfuses the donor liver after the donor’s death.

“NRP allows us to mitigate some of the organ damage that traditionally occurs with DCD livers when standard procurement or super rapid recovery procedures are performed,” Dr. Gupta says. “Not only have we seen a very significant increase in the number of liver transplants but also an overall improvement in outcomes for recipients. Research conducted at our institute shows that using NRP for DCD organs essentially renders them the same risk as organs donated after brain death.”

The second preservation technology is a pump that is used after the liver has been procured. The donor liver is continuously perfused with oxygenated blood, medications and nutrients at normal body temperature and near physiological pressure and flows. After placement on the pump, the liver is monitored for several hours to determine if it is functioning properly based on several parameters.

“This preservation system allows transplant programs to be more aggressive in accepting extended criteria organs since we can objectively evaluate the quality of the liver prior to transplant,” Dr. Gupta says. “In addition, it alleviates concerns about cold ischemic time because livers can routinely stay on pump for 12 hours. This also has removed some of the logistical challenges we’ve experienced when accepting two to three livers at the same time. Transplant procedures can be timed to make sure that every liver is transplanted by a well-rested and well-functioning team, which has been validated nationwide to lead to better outcomes.”

Baylor Dallas remains the leading medical center in the United States for robotic living donor hepatectomies. A recent analysis of the first 50 robotic hepatectomies performed at the medical center showed outcomes for donors and recipients are at least as good and possibly better than an open hepatectomy in terms of safety and overall outcomes. Tangible benefits to donors include decreased hernia rate, faster return to function, increased functionality and better cosmetic outcomes.