Zinan Yi1, Maria E Mayorga, Eric S Orman, Stephanie B Wheeler, Paul H Hayashi, A Sidney Barritt. 1. 1 Operations Research Graduate Program, North Carolina State University, Raleigh, NC. 2 Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC. 3 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN. 4 Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC. 5 Department of Medicine, University of North Carolina, Chapel Hill, NC.
Abstract
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 to 2025. The model was informed by data from the Organ Procurement and Transplant Network, 2003 to 2014. National data are estimated along with forecasts for 2 regions. RESULTS: Nonalcoholic steatohepatitis will increase from 18% of waitlist additions to 22% by 2025. Hepatitis C will fall from 30% to 21%. Listings over age 60 years 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 Model for End-Stage Liver Disease (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 nonalcoholic steatohepatitis 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.
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 to 2025. The model was informed by data from the Organ Procurement and Transplant Network, 2003 to 2014. National data are estimated along with forecasts for 2 regions. RESULTS:Nonalcoholic steatohepatitis will increase from 18% of waitlist additions to 22% by 2025. Hepatitis C will fall from 30% to 21%. Listings over age 60 years 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 Model for End-Stage Liver Disease (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 nonalcoholic steatohepatitis 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.
Authors: Eric S Orman; Maria E Mayorga; Stephanie B Wheeler; Rachel M Townsley; Hector H Toro-Diaz; Paul H Hayashi; A Sidney Barritt Journal: Liver Transpl Date: 2015-08 Impact factor: 5.799
Authors: Mark Roberts; Louise B Russell; A David Paltiel; Michael Chambers; Phil McEwan; Murray Krahn Journal: Med Decis Making Date: 2012 Sep-Oct Impact factor: 2.583
Authors: Natasha H Dolgin; Babak Movahedi; Paulo N A Martins; Robert Goldberg; Kate L Lapane; Frederick A Anderson; Adel Bozorgzadeh Journal: J Am Coll Surg Date: 2016-04-28 Impact factor: 6.113
Authors: Hector Toro-Díaz; Maria E Mayorga; A Sidney Barritt; Eric S Orman; Stephanie B Wheeler Journal: Med Decis Making Date: 2014-11-12 Impact factor: 2.583
Authors: Margaux N Mustian; Brittany A Shelton; Paul A MacLennan; Rhiannon D Reed; Jared A White; Devin E Eckhoff; Jayme E Locke; Richard M Allman; Stephen H Gray Journal: Transplantation Date: 2019-07 Impact factor: 4.939
Authors: Nikhilesh R Mazumder; Kofi Atiemo; Matthew Kappus; Giuseppe Cullaro; Matthew E Harinstein; Daniela Ladner; Elizabeth Verna; Jennifer Lai; Josh Levitsky Journal: Transplantation Date: 2020-02 Impact factor: 5.385
Authors: Sarah R Lieber; Ruth-Ann Lee; Yue Jiang; Claire Reuter; Randall Watkins; Kristen Szempruch; David A Gerber; Chirag S Desai; G Stephen DeCherney; A Sidney Barritt Journal: Clin Transplant Date: 2019-04-23 Impact factor: 3.456