Parikh Neehar D, Hutton David, Marrero Wesley, Sanghani Kunal, Xu Yongcai, Lavieri Mariel
Division of Gastroenterology, University of Michigan, Ann Arbor, MI.
School of Public Health, University of Michigan Ann Arbor, MI.
Liver Transpl. 2015 Jun;21(6):855-63. doi: 10.1002/lt.24136.
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.
随着美国人口老龄化、人口结构变化以及肥胖症的流行，当前肝脏供体短缺问题有可能进一步恶化。我们旨在预测美国肝脏移植供体的可获得性。我们对器官获取与移植网络数据库中2000年至2012年所有成年供体进行了二次分析，计算了每年按年龄、种族和体重指数（BMI）分组的可用供体总数以及已移植的供体肝脏数量。我们使用了美国国家健康和营养检查调查以及疾病控制与预防中心的历史数据，按年龄、性别、种族和BMI对普通人群进行分层。然后，我们利用美国人口普查局和韦尔登·库珀公共服务中心提供的美国人口年龄和种族预测数据，对2014年至2025年全国和各地区的可用供体及供体肝脏利用率进行了预测。我们进行了敏感性分析，改变了肥胖症上升率、西班牙裔比例、人口增长率、肝脏利用率以及心脏死亡后捐赠（DCD）利用率。预计2014年至2025年美国成年人口增长率为7.1%。然而，我们预计使用的肝脏移植数量将增加6.1%。肝脏供体增长存在明显的地区差异。预测受到BMI、DCD利用率和肝脏利用率变化的显著影响，但不受美国人口中西班牙裔比例变化或总体人口增长变化的影响。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脏移植短缺问题。不同器官共享联合网络地区的器官预计增长情况差异很大。有必要采取针对性策略来增加肝脏供体库。
