Trends in Characteristics of Patients Listed for Liver Transplantation Will Lead to Higher Rates of Waitlist Removal Due to Clinical Deterioration

Zinan Yi, Maria E. Mayorga, Eric Orman, Stephanie B. Wheeler, Paul H. Hayashi, A. Sidney Barritt

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2368-2374
Number of pages7
JournalTransplantation
Volume101
Issue number10
DOIs
StatePublished - Oct 1 2017

Fingerprint

Liver Transplantation
Transplants
End Stage Liver Disease
Liver
Tissue and Organ Procurement
Patient Dropouts
Hepatitis C
Epidemiology
Transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Trends in Characteristics of Patients Listed for Liver Transplantation Will Lead to Higher Rates of Waitlist Removal Due to Clinical Deterioration. / Yi, Zinan; Mayorga, Maria E.; Orman, Eric; Wheeler, Stephanie B.; Hayashi, Paul H.; Barritt, A. Sidney.

In: Transplantation, Vol. 101, No. 10, 01.10.2017, p. 2368-2374.

Research output: Contribution to journalArticle

Yi, Zinan ; Mayorga, Maria E. ; Orman, Eric ; Wheeler, Stephanie B. ; Hayashi, Paul H. ; Barritt, A. Sidney. / Trends in Characteristics of Patients Listed for Liver Transplantation Will Lead to Higher Rates of Waitlist Removal Due to Clinical Deterioration. In: Transplantation. 2017 ; Vol. 101, No. 10. pp. 2368-2374.
@article{868e979d88b14b05885537301c718fce,
title = "Trends in Characteristics of Patients Listed for Liver Transplantation Will Lead to Higher Rates of Waitlist Removal Due to Clinical Deterioration",
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.",
author = "Zinan Yi and Mayorga, {Maria E.} and Eric Orman and Wheeler, {Stephanie B.} and Hayashi, {Paul H.} and Barritt, {A. Sidney}",
year = "2017",
month = "10",
day = "1",
doi = "10.1097/TP.0000000000001851",
language = "English (US)",
volume = "101",
pages = "2368--2374",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Trends in Characteristics of Patients Listed for Liver Transplantation Will Lead to Higher Rates of Waitlist Removal Due to Clinical Deterioration

AU - Yi, Zinan

AU - Mayorga, Maria E.

AU - Orman, Eric

AU - Wheeler, Stephanie B.

AU - Hayashi, Paul H.

AU - Barritt, A. Sidney

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85031685354&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85031685354&partnerID=8YFLogxK

U2 - 10.1097/TP.0000000000001851

DO - 10.1097/TP.0000000000001851

M3 - Article

C2 - 28858174

AN - SCOPUS:85031685354

VL - 101

SP - 2368

EP - 2374

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 10

ER -