# A 23-Year Comprehensive Analysis of over 4000 Liver Transplants in Türkiye: Integrating Clinical Outcomes with Public Health Insights

## TL;DR

A 23-year study of over 4000 liver transplants in Türkiye reveals high use of living donors and age-specific disease patterns, offering insights for public health planning.

## Contribution

The study provides a comprehensive, long-term analysis of liver transplant trends and etiological patterns in Türkiye, emphasizing public health implications.

## Key findings

- Over 86% of liver transplants were living donor procedures, making it one of the highest-volume LDLT programs globally.
- Infectious causes dominated adult liver disease, while toxic, bile duct, and metabolic disorders were more common in pediatric recipients.

## Abstract

What are the main findings?
This 23-year single center analysis of 4011 liver transplants demonstrates that over 86% of procedures were living donor liver transplants, positioning the center among the highest-volume LDLT programs globally.Distinct and clinically relevant age dependent etiological patterns were identified: infectious causes dominated adults, whereas toxic etiologies, bile duct diseases, and metabolic disorders were predominant in pediatric recipients.

This 23-year single center analysis of 4011 liver transplants demonstrates that over 86% of procedures were living donor liver transplants, positioning the center among the highest-volume LDLT programs globally.

Distinct and clinically relevant age dependent etiological patterns were identified: infectious causes dominated adults, whereas toxic etiologies, bile duct diseases, and metabolic disorders were predominant in pediatric recipients.

What are the implications of the main findings?
The high living donor rate highlights the need for strengthening donor safety policies, regional public health planning, and organ donation awareness programs across Türkiye.The age specific etiological differences can guide targeted prevention, early diagnosis, and optimized allocation of healthcare resources for diverse patient groups

The high living donor rate highlights the need for strengthening donor safety policies, regional public health planning, and organ donation awareness programs across Türkiye.

The age specific etiological differences can guide targeted prevention, early diagnosis, and optimized allocation of healthcare resources for diverse patient groups

Background: This study seeks to evaluate the 23 year experience of the İnonu University Liver Transplantation Institute from a public health perspective by examining demographic patterns, etiological factors, and transplantation trends between 2002 and 2025. Aims: This analysis aims to provide insights into the epidemiological landscape of liver transplantation in Türkiye from a public health perspective. Methods: In this retrospective cross sectional study, we analyzed 4011 liver transplant procedures performed between March 2002 and March 2025. Recipient demographics, disease etiologies, donor characteristics, and patients geographic distribution were assessed to delineate regional health needs and service utilization patterns. Results: A total of 4011 patients were included. The cohort comprised 2618 males (65.3%) and 1393 females (34.7%). Recipients were classified as adult (n = 3232, 80.9%) or pediatric (n = 779, 19.1%). Among adults, infectious etiologies were the most prevalent (35.5%), followed by cryptogenic liver cirrhosis (24.7%). In contrast, pediatric patients most commonly presented with toxic etiologies (29.4%), metabolic disorders (22.6%) and bile duct diseases (15.9%). Most liver transplantations were performed using living donors (n = 3481, 86.8%), while deceased donors accounted for 530 procedures (13.2%). Additionally, 244 living donor liver transplantations were performed via liver paired exchange (LPE). Conclusions: These findings may inform resource allocation, health policy development, and the optimization of transplantation services. This center-based model offers a useful framework for characterizing regional health needs and strengthening community health, particularly through prevention, screening, and early intervention strategies for liver diseases.