Myoung Soo Kim; Kwang Woong Lee; Shin Hwang; Choon Hyuck David Kwon; Young Kyoung You; Yang Won Nah; Hee Chul Yu; Dong Sik Kim; Hee Jung Wang; Dong Lak Choi; In Seok Choi; Soon Il Kim

doi:10.4285/jkstn.2014.28.2.59

Journal List > J Korean Soc Transplant > v.28(2) > 1034449

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Lee, Hwang, Kwon, You, Nah, Yu, Kim, Wang, Choi, Choi, and Kim: Research for Modification of Emergency Status in Deceased Donor Liver Allocation – Survival Analysis of Waiting Patients for Liver Transplantation

Review Article

J Korean Soc Transplant 2014;28(2):59-68.

Published online: 10 June 2014

DOI: https://doi.org/10.4285/jkstn.2014.28.2.59

Research for Modification of Emergency Status in Deceased Donor Liver Allocation – Survival Analysis of Waiting Patients for Liver Transplantation

Myoung Soo Kim, M.D., Kwang Woong Lee, M.D., Shin Hwang, M.D., Choon Hyuck David Kwon, M.D., Young Kyoung You, M.D., Yang Won Nah, M.D., Hee Chul Yu, M.D., Dong Sik Kim, M.D., Hee Jung Wang, M.D., Dong Lak Choi, M.D., In Seok Choi, M.D., Soon Il Kim, M.D.

Committee of Liver Disease Severity for Liver Transplantation, The Korean Society for Transplantation, Korea

책임저자：김명수, 서울특별시 서대문구 연세로 50-1연세대학교 의과대학 외과학교실, 120-752 Tel: 02-2228-2123, Fax: 02-313-8289 E-mail: ysms91@yuhs.ac

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Despite a remarkable increase of deceased donors, organ shortage is the main hurdle of organ transplantation in Korea. Therefore, liver transplantation priority is a major issue of liver allocation. We confront a situation that needs to change in order to achieve more adequate and objective allocation of the system. We considered the MELD system as an alternative to the CTP score and Status system. For application of the MELD system, comparison between two systems is required; and a national-based retrospective review of liver transplantation candidates (waiting list) was conducted as a multicenter collaborative study. Eleven transplant centers participated in this national study. From 2009 to 2012, 2,702 waiting lists were enrolled. After mean 349±412 days follow-up, 967 patients (35.8%) of liver transplantation, 750 patients (27.8%) of drop-out/mortality, and 719 patients (26.6%) on waiting were identified. In analysis of patient mortality during waiting time, status system showed significant difference of waiting mortality by status at registration. However, differences of waiting mortality by MELD system were more prominent and discriminate. In comparisons by MELD score in exclusive Status 2A waiting patients, there was a significant difference of waiting mortality by MELD score. This means that the MELD system is a good predictor of short-term survival after listing compared with status system with CTP score. Korean national-based retrospective study showed the superiority of the MELD system in prediction of short-term mortality and usefulness as a determinant for allocation priority.

Keywords: Resource allocation, Liver transplantation, End stage liver disease

References

1). Kim MS, Kim SI, Kim YS. Current status of deceased donor organ recovery and sharing in Korea. J Korean Med Assoc. 2008; 51:685–91.

2). Wiesner RH, McDiarmid SV, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, et al. MELD and PELD: application of survival models to liver allocation. Liver Transpl. 2001; 7:567–80.

3). Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000; 31:864–71.

4). Santori G, Andorno E, Morelli N, Antonucci A, Bottino G, Mondello R, et al. MELD score versus conventional UNOS status in predicting short-term mortality after liver transplantation. Transpl Int. 2005; 18:65–72.

5). Dutkowski P, Oberkofler CE, Béchir M, Müllhaupt B, Geier A, Raptis DA, et al. The model for end-stage liver disease allocation system for liver transplantation saves lives, but increases morbidity and cost: a prospective outcome analysis. Liver Transpl. 2011; 17:674–84.

6). Cywinski JB, Mascha EJ, You J, Sessler DI, Kapural L, Argalious M, et al. Pre-transplant MELD and sodium MELD score are poor predictors of graft failure and mortality after liver transplantation. Hepatol Int. 2011; 5:841–9.

7). Korean Network for Organ Sharing (KONOS). 2010 Annual Data Report [Internet]. Seoul: KONOS;2011. [cited 2012 May 5]. Available from:. http://www.konos.go.kr.

8). Kim MS, Kim SI, Kim YS. Current status of deceased donor organ recovery and sharing in Korea. J Korean Med Assoc. 2008; 51:685–91.

9). Joo DJ, Kim MS, Kim SI, Jeon KO, Huh KH, Choi GH, et al. Severity of end-stage liver disease in liver transplant candidate; comparison of KONOS status with MELD score. J Korean Soc Transplant. 2012; 26:112–9.

10). Hong G, Lee KW, Suh SW, Yoo T, Kim H, Park MS, et al. The model for end-stage liver disease score-based system predicts short term mortality better than the current Child-Turcotte-Pugh score-based allocation system during waiting for deceased liver transplantation. J Korean Med Sci. 2013; 28:1207–12.

11). Korean Network for Organ Sharing (KONOS). 2012 Annual Data Report [Internet]. Seoul: KONOS;2012. [cited 2013 Nov 5]. Available from:. http://www.konos.go.kr.

12). Institute of Medicine (U.S.). Analysis of waiting times. Committee on Organ Procurement and Transplantation Policy, Institute of Medicine (U.S.). Organ procurement and transplantation: assessing current policies and the potential impact of the DHHS final rule. Washington, D.C.: National Academy Press;1999. p. 57–9.

13). Said A, Williams J, Holden J, Remington P, Gangnon R, Musat A, et al. Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease. J Hepatol. 2004; 40:897–903.

14). Freeman RB Jr, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E, et al. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl. 2002; 8:851–8.

Fig. 1.

Overview of liver transplant candidate (waiting list). Abbreviations: HCC, hepatocellular carcinoma.

Fig. 2.

Overall liver transplantation rate after registration by status.

Fig. 3.

Deceased donor liver transplantation rate after registration by status.

Fig. 4.

Living donor liver transplantation rate after registration by status.

Fig. 5.

Waiting list survival rate after registration by status.

Fig. 6.

Waiting list survival rate after registration by MELD score. Abbreviation: MELD, model for end-stage liver disease.

Fig. 7.

Waiting list survival rate after registration by MELD score in Status 2A. Abbreviation: MELD, model for end-stage liver disease.

Fig. 8.

Waiting list survival rate after registration by MELD score in Status 2B. Abbreviation: MELD, model for end-stage liver disease.

Fig. 9.

Waiting list survival rate after registration by MELD score in Status 3. Abbreviation: MELD, model for end-stage liver disease.

Fig. 10.

Overview of liver transplant candidate with hepatocellular carcinoma. Abbreviations: HCC, hepatocellular carcinoma; LD, liver disease.

Fig. 11.

Liver transplantation rate by hepatocellular carcinoma. Abbreviation: HCC, hepatocellular carcinoma.

Fig. 12.

Recurrence rate of hepatocellular carcinoma during waiting time. Abbreviation: HCC, hepatocellular carcinoma. ^a Exclude center No. = 2 due to incomplete date.

Fig. 13.

Different effects of MELD score on waiting list survival rate by hepatocellular carcinoma. Abbreviations: MELD, model for end-stage liver disease; HCC, hepatocellular carcinoma.

Fig. 14.

Liver transplantation rate after registration.

Fig. 15.

Yearly census of liver transplantation in Korea. Abbreviation: DD, deceased donor.

Table 1.

Transplantation center list

장기이식센터	책임자 ^a	소속 및 직위	자료관리자	증례수
연세대 세브란스병원	김명수	연세의대 교수 연구책임자	전경옥	399
서울삼성병원	권준혁	성균관의대 교수	홍승희, 이윤미, 강은진	538
고려대학교 병원(안암)	김동식	고려의대 교수	김수진	66
울산대병원	나양원	울산의대 교수	송순경, 권은경	94
아주대병원	왕희정	아주대의대 교수	이미영	54
서울성모병원	유영경	가톨릭의대 교수	한재현	102
전북대병원	유희철	전북의대 교수	성 숙	83
서울대병원	이광웅	서울의대 교수	이광웅	657
대구카톨릭대병원	최동락	가톨릭의대 교수	한영석	48
건양대병원	최인석	건양의대 교수	김경순	12
서울아산병원	황 신	울산의대 교수	장지연	649
				2,702

^a 연구책임자 외 참여 연구자는 가나다순임.

TOOLS

Similar articles