Orman Eric S, Mayorga Maria E, Wheeler Stephanie B, Townsley Rachel M, Toro-Diaz Hector H, Hayashi Paul H, Barritt A Sidney
Department of Medicine, University of North Carolina, Chapel Hill, NC.
Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN.
Liver Transpl. 2015 Aug;21(8):1040-50. doi: 10.1002/lt.24160.
National liver transplantation (LT) volume has declined since 2006, in part because of worsening donor organ quality. Trends that degrade organ quality are expected to continue over the next 2 decades. We used the United Network for Organ Sharing (UNOS) database to inform a 20-year discrete event simulation estimating LT volume from 2010 to 2030. Data to inform the model were obtained from deceased organ donors between 2000 and 2009. If donor liver utilization practices remain constant, utilization will fall from 78% to 44% by 2030, resulting in 2230 fewer LTs. If transplant centers increase their risk tolerance for marginal grafts, utilization would decrease to 48%. The institution of "opt-out" organ donation policies to increase the donor pool would still result in 1380 to 1866 fewer transplants. Ex vivo perfusion techniques that increase the use of marginal donor livers may stabilize LT volume. Otherwise, the number of LTs in the United States will decrease substantially over the next 15 years. In conclusion, the transplant community will need to accept inferior grafts and potentially worse posttransplant outcomes and/or develop new strategies for increasing organ donation and utilization in order to maintain the number of LTs at the current level.
自2006年以来，全国肝移植（LT）数量呈下降趋势，部分原因是供体器官质量恶化。预计在未来20年中，降低器官质量的趋势仍将持续。我们使用器官共享联合网络（UNOS）数据库进行了一项为期20年的离散事件模拟，以估计2010年至2030年的肝移植数量。用于构建该模型的数据来自2000年至2009年间的已故器官捐赠者。如果供体肝脏的利用方式保持不变，到2030年，利用率将从78%降至44%，导致肝移植数量减少2230例。如果移植中心提高对边缘性移植物的风险承受能力，利用率将降至48%。实行“默认同意”器官捐赠政策以增加供体库，仍会导致移植数量减少1380至1866例。增加边缘性供体肝脏使用的体外灌注技术可能会稳定肝移植数量。否则，未来15年美国的肝移植数量将大幅减少。总之，移植界需要接受质量较差的移植物以及可能更差的移植后结果，和/或制定增加器官捐赠和利用的新策略，以便将肝移植数量维持在当前水平。
