Orthotopic liver transplantation was performed more often in 1989 than in 1988. This procedure was performed at 57 institutions in 1988 and at 64 in 1989. Among the 53 institutions in which OLTX was performed in both years, the tendency was to increase volume. Volume in 1988 was not an indicator for volume increase or decrease in the next year. For example, about 60% of the centers which performed 5-9 OLTXs in 1988 had a greater volume in 1989. This was similar to the percentage among centers which performed 30-49 OLTXs in 1988. Only centers which performed at least 100 OLTXs in 1988 increased in volume uniformly (3 centers). There was about a 25% increase in the number of OLTX recipients, and the characteristics of the recipient population changed. In 1989, as compared to 1988, there was a larger proportion of recipients over age 40 with a concomitant proportionate decrease in pediatric recipients. Indications for OLTX were also different. In 1988, biliary atresia and primary biliary cirrhosis were the major diagnoses for which OLTX was performed. In 1989, however, alcoholic cirrhosis was the most prevalent diagnosis among OLTX recipients, accounting for more than 1 of every 7 procedures. We also found that the distribution of UNOS description changed. Significantly more recipients were classified in the best functional group, and significantly more recipients were on life support in 1989 compared to 1988. Whether this reflects a change in the actual functional status of recipients, or change in the management of these patients, is a topic for further research.(ABSTRACT TRUNCATED AT 250 WORDS)