Severity of End-stage Liver Disease in Liver Transplant Candidate; Comparison of KONOS Status with MELD Score

Dong Jin Joo; Myoung Soo Kim; Soon Il Kim; Kyung Ok Jeon; Kyu Ha Huh; Gi Hong Choi; Jin Sub Choi

doi:10.4285/jkstn.2012.26.2.112

Journal List > J Korean Soc Transplant > v.26(2) > 1034367

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Joo, Kim, Kim, Jeon, Huh, Choi, and Choi: Severity of End-stage Liver Disease in Liver Transplant Candidate; Comparison of KONOS Status with MELD Score

Original Article

The Journal of the Korean Society for Transplantation

The Journal of the Korean Society for Transplantation 2012; 26(2): 112-119.

Published online: 29 June 2012

DOI: https://doi.org/10.4285/jkstn.2012.26.2.112

Severity of End-stage Liver Disease in Liver Transplant Candidate; Comparison of KONOS Status with MELD Score

Dong Jin Joo, M.D.^1,², Myoung Soo Kim, M.D.^1,², Soon Il Kim, M.D.^1,², Kyung Ok Jeon, R.N.², Kyu Ha Huh, M.D.^1,², Gi Hong Choi, M.D.^1,², Jin Sub Choi, M.D.^1,²

¹Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

²Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author (ysms91@yuhs.ac)

Received 11 April 2012 Accepted 29 May 2012

Abstract

Background

We have allocated liver according to the Korean Network Organ Sharing (KONOS) status. However, it was necessary to change the system to a more adequate and objective system. We analyzed the correlation between KONOS status and MELD score under the current status of organ allocation.

Methods

We reviewed medical records of 70 liver recipients as KONOS status 2A and 2B between September 2005 and December 2010. We analyzed their KONOS status, MELD score, clinical characteristics, waiting time, Child-Turcotte-Pugh (CTP) score and clinical symptoms accorded to KONOS status 2A.

Results

Mean MELD and CTP score of the 2A group was significantly higher than the 2B group (P<0.001). In the 2B group, the blood types of all recipients were identical to those of the donors. However, 2A group included 7 cases (23.3%) of non-identical blood types. The MELD score of all recipients were correlated with CTP score (R=0.798, P<0.001). However, there was an overlapping area between the 2B group and the 2A group that was registered by the condition of intractable ascites. Those who had hepatorenal syndrome and hepatic encephalopathy showed high MELD score over 20. However, 36.4% of the patients who had only intractable ascites showed a MELD score of less than 20.

Conclusions

CTP score was highly correlated with MELD score. However, KONOS status showed some overlapping area of the MELD score between 2A and 2B groups. We should make an effort to improve KONOS allocation system to meet the Korean situation.

Keywords: Liver transplantation, Tissue and organ procurement, Resource allocation, Severity of illness index

Figures and Tables

Fig. 1

Correlation between MEDL score and CTP score. Correlation analysis, r=0.798 (P<0.0001), Linear regression, R²=0.636 (P<0.0001).

Fig. 2

MELD score by pre-transplant KONOS status and inclusion criteria of Status 2A. Abbreviations: HEP, hepatic encephalopathy; HRS, hepatorenal syndrome; Ascites (+), ascites drainage more than 4 L/week; HEP (+), hepatic encephalopathy more than Grade 2; HRS (+), hepatorenal syndrome with serum creatinine≥4 mg/dL or need hemodialysis. ^aP<0.05 versus Status 2B; ^bP<0.05 versus Status 2B; ^cP<0.05 versus Ascites only; ^dP<0.05 versus HEP (+)/HRS (-).

Fig. 3

MELD score distribution by KONOS status with different symptoms. Abbreviations: HEP, hepatic encephalopathy; HRS, hepatorenal syndrome.

Table 1

Clinical manifestations between status 2A and 2B

Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; HCC, hepatocellular carcinoma; CTP score, Child-Turcotte-Pugh score; MELD score, model for end stage liver disease score.

Table 2

Organ allocation by ABO blood type

Table 3

Donor factors between status 2A and 2B

Abbreviations: BMI, body mass index; HOPO, hospital organ procurement organization.

Table 4

Clinical status by KONOS status

^aInclusion criteria for KONOS status 2A.

Table 5

MELD score by pre-transplant clinical status

^aP<0.01 versus non-symptomatic group.

References

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