The Pitt-UNOS Liver Transplant Registry maintains a computerized database of all orthotopic liver transplantations (OLTX) performed in the United States since October 1, 1987. Recipient data, which are collected at the time of transplantation and at specified follow-up time periods, are reported to the Registry directly, while donor data are transmitted through UNOS Central. During the first year of registration (October 1, 1987 through September 30, 1988), 1,561 liver transplantations were performed on 1,377 patients; 146 patients received 2 livers and another 19 patients received 3 livers. There were 29 multiorgan transplants, including 18 liver/kidney, 7 liver/pancreas, 1 liver/small bowel, 2 liver/kidney/heart, and 1 liver/kidney/pancreas. Among the 52 centers reporting at least 1 liver transplant during this time period, 34 (65%) performed less than 20 procedures and only 7 (13%) performed at least 50 transplantations. Sixty-three percent of the donors were male; 63% were less than 25 years of age and in 72% the cause of death was motor vehicle accidents, gunshot wounds, or cerebrovascular accidents. Recipients were older than donors, 37% above age 45. About 25% of the recipients required intensive care or life support. The majority suffered from cirrhosis of cholestatic, autoimmune, viral, alcoholic, or unspecified etiology. The 6-month cumulative survival following OLTX was 76%, and the 6-month retransplant-free survival rate was 69%. Survival rates at 1 year were 72% and 64%, respectively. Factors associated with patient survival were diagnosis of liver disease and work (UNOS) status. Patients with fulminant liver failure or malignancies had the poorest survival, and patients with cholestatic cirrhosis or other cirrhosis had the best.(ABSTRACT TRUNCATED AT 250 WORDS)