[Two decades of liver transplantation in Israel].

During the years 1991-2011, 769 liver transplantations were registered in the Israeli National Transplantation Center. Data from the Israeli Transplantation Center and from the Collaborative Transplantation Study was used. The majority of liver transplantations were adult cadaveric transplantation. There is an increase in adult-adult living donation during the last decade (9%) compared with the previous decade (1.7%). Pediatric transplantations increased from 3.3% to 15%, while up to 30% are from living donors. Simultaneous liver-kidney transplantations (SLK) account for 6% of all transplantations, regardless of the change in the allocation scheme to the Model for End-Stage Liver Disease (MELD) score during 2005. The most common primary liver disease among liver transplant patients is hepatitis C virus (HCV) (34%) and the leading cause for liver transplantation since 2006 is hepatocellular carcinoma (31%). One year patient survival did not change significantly during two decades: 74.8 and 79.1%, respectively, although 5 years survival has increased during that period, from 54.9% to 67.3% (p = 0.05). Average annual mortality beyond the first year stands at 2.47%. The use of old donors (> 50) increased from 36.6% during 1991-1999 to 46% in the years 2005-2009. During two decades of liver transplantation in Israel, facing a severe shortage of organs, there is increased usage from old donors, as well as living donations for pediatric and adult patients. The use of living donors for urgent adult liver transplantation is common. Survival after liver transplantation has improved.