Declining liver graft quality threatens the future of liver transplantation in the United States

Orman, Eric S.; Mayorga, Marı́a E.; Wheeler, Stephanie B.; Townsley, Rachel M.; Toro-Díaz, Hector; Hayashi, Paul H.; Barritt, A. Sidney

doi:10.1002/lt.24160

Cited by 110 publications

(112 citation statements)

References 47 publications

(65 reference statements)

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“…These issues have been raised previously,(6) but deserve updated emphasis as healthcare costs continue to spiral upwards. For example, complicated variceal bleeding may increase, which would lead to high hospitalization costs of $28 513 per patient in 2015 US dollars (adjusted for inflation from 2008 US dollars using the Consumer Price Index Medical Care component for all US cities).…”

Section: Discussionmentioning

confidence: 88%

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Trends in Characteristics of Patients Listed for Liver Transplantation Will Lead to Higher Rates of Waitlist Removal Due to Clinical Deterioration

Mayorga

Orman

et al. 2017

Transplantation

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Background Changes in the epidemiology of end stage liver disease may lead to increased risk of dropout from the liver transplant waitlist. Anticipating the future of liver transplant waitlist characteristics is vital when considering organ allocation policy. Methods We performed a discrete event simulation to forecast patient characteristics and rate of waitlist dropout. Estimates were simulated from 2015–2025. The model was informed by data from the Organ Procurement and Transplant Network, 2003–2014. National data are estimated along with forecasts for 2 regions. Results NASH will increase from 18% of waitlist additions to 22% by 2025. Hepatitis C will fall from 30% to 21%. Listings over age 60 will increase from 36% to 48%. The hazard of dropout will increase from 41% to 46% nationally. Wait times for transplant for patients listed with a MELD between 22 and 27 will double. Region 5, which transplants at relatively higher MELD scores, will experience an increase from 53% to 64% waitlist dropout. Region 11, which transplants at lower MELD scores, will have an increase in waitlist dropout from 30% to 44%. Conclusions The liver transplant waitlist size will remain static over the next decade due to patient dropout. Liver transplant candidates will be older, more likely to have NASH and will wait for transplantation longer even when listed at a competitive MELD score. There will continue to be significant heterogeneity among transplant regions where some patients will be more likely to drop out of the waitlist than receive a transplant.

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Section: Discussionmentioning

confidence: 88%

“…(5) The recent decline in LT may be a harbinger of further reductions in LT in the coming years. (6) Such a decline in transplant availability would place a greater burden on centers managing ESLD patients on the waitlist.…”

Section: Introductionmentioning

confidence: 99%

Trends in Characteristics of Patients Listed for Liver Transplantation Will Lead to Higher Rates of Waitlist Removal Due to Clinical Deterioration

Mayorga

Orman

et al. 2017

Transplantation

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“…This is the reason for which every possible deceased donor is thoroughly evaluated by organ procurement associations and transplant physicians. A variety of algorithms have been implemented in order to assess the risk of graft failure after liver transplantation [13] in an attempt to better match grafts and recipients. One of these scores -the donor risk index [4], used in our study, is being extensively used by centers worldwide and incorporates variables regarding the physical status of the patient, the cause of cerebral death, organ allocation and cold ischemic time.…”

Section: Discussionmentioning

confidence: 99%

“…Orman et al [13] published a study where they analyzed the impact of donor organs by the year 2030 considering the actual trend. They found that the use will fall from 78% to 44% by 2030, resulting in 2230 fewer LTs.…”

Section: Discussionmentioning

confidence: 99%

The impact of donor liver graft quality on postoperative outcome in liver transplant recipients. A single centre experience

Tomescu

Popescu

Jipa

et al. 2016

Rom J Anaesth Int Care

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Introduction. The Donor Risk Index (DRI) has become a universal score for organ allocation in liver transplantation (LT) worldwide. The aim of this study was to evaluate the impact of liver graft quality measured by DRI, CIT, WIT and donor age on intraoperative hemodynamics (reperfusion syndrome) and early postoperative outcome, defined as initial graft poor function (within 3 days of LT), of deceased donor liver transplant (DDLT) recipients. Secondary end-points were the assessment of the impact of graft quality on the intraoperative and postoperative day 1 hemostasis (evaluated using ROTEM assay). Methods. We retrospectively analyzed 135 patients who underwent deceased-donor LT between January 2013 and December 2014. Patient demographic data (age, sex, cause of End-Stage Liver Disease), preoperative paraclinical data (total bilirubin, creatinine, serum sodium), severity of liver disease scores (Model for End-Stage Liver Disease -MELD and MELD-sodium), intraoperative blood loss and blood products transfusion, incidence of post reperfusion syndrome, postoperative biochemical data (including total bilirubin, hepatic transaminases, lactate levels) and outcome (initial graft poor function diagnosis) were noted. Donor characteristics including DRI, CIT, WIT and donor age were noted. Coagulation was assessed by rotational thromboelastometry (ROTEM) after reperfusion of the graft and on postoperative day 1 in order to determine the effects of liver graft quality on hemostasis. Results. Donor age has significantly correlated with decreased derived ROTEM parameters time to the maximum velocity of clot formation -MaxVt (p = 0.000), area under the curve (AUC) (p = 0.008) and maximum clot elasticity (MCE) (p = 0.018) although no difference in transfusion requirements has been observed. A longer CIT was associated with an increase in AST and ALT observed during the early postoperative period: day 1 ALT (p = 0.032) and AST (p = 0.008), day 2 ALT (p = 0.001) and AST (p = 0.001) and day 3 AST (p = 0.010) and ALT (p = 0.001). Higher DRI correlated with higher bilirubin levels measured on postoperative day 1 (p = 0.027) and 2 (p = 0.001). Patients who developed initial graft poor function received liver grafts from older donors (p = 0.05) with a higher DRI (p = 0.002). Conclusion. Our results suggest a significant impact of donor age and DRI on perioperative coagulation kinetics that may be a result of initial graft poor function. Although CIT and DRI correlated with a more severe cholestasis and hepatocitolysis during the early postoperative period these seems to be short-lived.

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“…The demand for liver transplantation, like other organs, continues to rise with no corresponding rise in supply-with the obesity epidemic projected to decrease the available pool of donor organs [28,29]. Liver tissue engineering seeks to overcome these issues by creating functional, viable, and biocompatible hepatic tissue for those with ESLD [30].…”

Section: Livermentioning

confidence: 99%

Whole-Organ Tissue Engineering: No Longer Just a Dream

Wrenn

Weiss

2016

Curr Pathobiol Rep

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Purpose of Review The true potential of the field of transplant surgery remains limited due to shortages of available transplantable allografts and, following transplantation, acute and chronic rejection with need for lifelong immune suppression. An alternative approach is to bioengineer organs to be utilized in vivo, replacing diseased or malfunctioning human organs. This revolutionary step in medicine could have virtually unlimited therapeutic potential. Recent Findings Multiple strategies have been used to replicate functional transplantable organs without deleterious host immune response. Common approaches include the use of decellularized tissue scaffolds and of 3D bioprinting. Continuing challenges include engraftment and maturation of recipient cells, and long-term tissue viability and function. Summary We will review in brief the history of the field and the progress to date with multiple organ systems, highlighting our personal experience in lung regeneration. Finally, we will discuss the challenges that lie ahead to reach the dream of fully functional and transplantable bioengineered organs.

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Declining liver graft quality threatens the future of liver transplantation in the United States

Cited by 110 publications

References 47 publications

Trends in Characteristics of Patients Listed for Liver Transplantation Will Lead to Higher Rates of Waitlist Removal Due to Clinical Deterioration

Trends in Characteristics of Patients Listed for Liver Transplantation Will Lead to Higher Rates of Waitlist Removal Due to Clinical Deterioration

The impact of donor liver graft quality on postoperative outcome in liver transplant recipients. A single centre experience

Whole-Organ Tissue Engineering: No Longer Just a Dream

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