Projections in donor organs available for liver transplantation in the United States: 2014-2025
Projections in donor organs available for liver transplantation in the United States: 2014-2025
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DOI：
10.1002/lt.24136
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发表时间：
2015-06-01
影响因子：
4.6
通讯作者：
Lavieri, Mariel
中科院分区：
文献类型：
--
作者：
Parikh, Neehar D.;Hutton, David;Lavieri, Mariel
随着美国人口老龄化、人口结构变化和肥胖的流行，目前肝脏供体短缺的情况可能会进一步加剧。我们的目标是预测肝移植在美国的可用性。我们对2000年至2012年所有成年供体的器官获取和移植网络数据库进行了二次分析，并按年龄、种族和体重指数（BMI）分组计算了每年可用供体和移植供体肝脏的总数。我们使用国家健康与营养调查和疾病控制与预防中心的历史数据，按年龄、性别、种族和BMI对一般人群进行分层。然后，我们使用美国人口普查局和威尔登库珀公共服务中心提供的美国人口年龄和种族预测，并对2014年至2025年的国家和地区可用供体和供体肝脏利用率进行了预测。我们进行了敏感性分析，并改变了肥胖率上升、西班牙裔比例、人口增长、肝脏利用率和心脏死亡后捐赠（DCD）利用率。从2014年到2025年，美国预计成年人口增长率为7.1%。然而，我们预计使用肝移植的数量将增加6.1%。肝供体生长存在明显的区域异质性。BMI、DCD使用率和肝脏使用率的变化显著影响预测，但不受美国人口中西班牙裔比例的变化或总体人口增长的变化的影响。总体人口增长将超过可用供体器官的增长，从而可能加剧现有的肝移植短缺。在不同的器官共享联合网络区域中，器官的预测增长是高度异质性的。有针对性的策略来增加肝脏供体池是必要的。中华医学杂志，2015,21(2):855-863。(c) 2015 AASLD。
With the aging US population, demographic shifts, and obesity epidemic, there is potential for further exacerbation of the current liver donor shortage. We aimed to project the availability of liver grafts in the United States. We performed a secondary analysis of the Organ Procurement and Transplantation Network database of all adult donors from 2000 to 2012 and calculated the total number of donors available and transplanted donor livers stratified by age, race, and body mass index (BMI) group per year. We used National Health and Nutrition Examination Survey and Centers for Disease Control and Prevention historical data to stratify the general population by age, sex, race, and BMI. We then used US population age and race projections provided by the US Census Bureau and the Weldon Cooper Center for Public Service and made national and regional projections of available donors and donor liver utilization from 2014 to 2025. We performed sensitivity analyses and varied the rate of the rise in obesity, proportion of Hispanics, population growth, liver utilization rate, and donation after cardiac death (DCD) utilization. The projected adult population growth in the United States from 2014 to 2025 will be 7.1%. However, we project that there will be a 6.1% increase in the number of used liver grafts. There is marked regional heterogeneity in liver donor growth. Projections were significantly affected by changes in BMI, DCD utilization, and liver utilization rates but not by changes in the Hispanic proportion of the US population or changes in the overall population growth. Overall population growth will outpace the growth of available donor organs and thus potentially exacerbate the existing liver graft shortage. The projected growth in organs is highly heterogeneous across different United Network for Organ Sharing regions. Focused strategies to increase the liver donor pool are warranted. Liver Transpl 21:855-863, 2015. (c) 2015 AASLD.