Future Economics of Liver Transplantation: A 20-Year Cost Modeling Forecast and the Prospect of Bioengineering Autologous Liver Grafts

Abstract

During the past 20 years liver transplantation has become the definitive treatment for most severe types of liver failure and hepatocellular carcinoma, in both children and adults. In the U.S., roughly 16,000 individuals are on the liver transplant waiting list. Only 38% of them will receive a transplant due to the organ shortage. This paper explores another option: bioengineering an autologous liver graft. We developed a 20-year model projecting future demand for liver transplants, along with costs based on current technology. We compared these cost projections against projected costs to bioengineer autologous liver grafts. The model was divided into: 1) the epidemiology model forecasting the number of wait-listed patients, operated patients and postoperative patients; and 2) the treatment model forecasting costs (pre-transplant-related costs; transplant (admission)-related costs; and 10-year post-transplant-related costs) during the simulation period. The patient population was categorized using the Model for End-Stage Liver Disease score. The number of patients on the waiting list was projected to increase 23% over 20 years while the weighted average treatment costs in the pre-liver transplantation phase were forecast to increase 83% in Year 20. Projected demand for livers will increase 10% in 10 years and 23% in 20 years. Total costs of liver transplantation are forecast to increase 33% in 10 years and 81% in 20 years. By comparison, the projected cost to bioengineer autologous liver grafts is $9.7M based on current catalog prices for iPS-derived liver cells. The model projects a persistent increase in need and cost of donor livers over the next 20 years that’s constrained by a limited supply of donor livers. The number of patients who die while on the waiting list will reflect this ever-growing disparity. Currently, bioengineering autologous liver grafts is cost prohibitive. However, costs will decline rapidly with the introduction of new manufacturing strategies and economies of scale.

Sustained In Vivo Perfusion of a Re-Endothelialized Tissue Engineered Porcine Liver

“…demand for transplantable organs projected to rise by 23% in the next 20 years [10], the gap between waitlist needs and organs available for transplantation will only increase. For this reason, alternative paradigms to traditional whole organ liver transplantation have been envisaged, including tissue engineering of transplantable liver grafts.…”

Advances in the Knowledge about Kidney Decellularization and Repopulation

“…The use of pig kidneys for tissue engineering is an attractive approach, mainly because the size of porcine organs is similar to that of humans, and pig scaffolds may allow better adhesion, survival, and maintenance of human cells than scaffolds obtained from dogs or monkeys (Nakayama et al, 2010; Song and Ott, 2011; Faulk et al, 2014a,b; Habka et al, 2015; Moini et al, 2015; Rana et al, 2017; Lih et al, 2016; McKee and Wingert, 2016). The idea of building a functional kidney using specific stem cells from the patient supports a tangible alternative.…”

Xenogeneic chimera—Generated by blastocyst complementation—As a potential unlimited source of recipient‐tailored organs

“…Overall, experts estimate that kidney transplantation saves around 200 000 USD/patient in the first 5 years . The cost of a liver transplantation is about 1.5 million USD per patient followed for 1 year, and it is related to the severity of disease at the time of transplantation . A patient with a MELD (model for end‐stage liver disease) of 40 induces a cost 60 times higher than a patient with a MELD 9 .…”