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.
References
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Fig. 1.
Overview of liver transplant candidate (waiting list). Abbreviations: HCC, hepatocellular carcinoma.
![jkstn-28-59f1.tif](/upload/SynapseXML/0083jkstn/thumb/jkstn-28-59f1.gif)
Fig. 6.
Waiting list survival rate after registration by MELD score. Abbreviation: MELD, model for end-stage liver disease.
![jkstn-28-59f6.tif](/upload/SynapseXML/0083jkstn/thumb/jkstn-28-59f6.gif)
Fig. 7.
Waiting list survival rate after registration by MELD score in Status 2A. Abbreviation: MELD, model for end-stage liver disease.
![jkstn-28-59f7.tif](/upload/SynapseXML/0083jkstn/thumb/jkstn-28-59f7.gif)
Fig. 8.
Waiting list survival rate after registration by MELD score in Status 2B. Abbreviation: MELD, model for end-stage liver disease.
![jkstn-28-59f8.tif](/upload/SynapseXML/0083jkstn/thumb/jkstn-28-59f8.gif)
Fig. 9.
Waiting list survival rate after registration by MELD score in Status 3. Abbreviation: MELD, model for end-stage liver disease.
![jkstn-28-59f9.tif](/upload/SynapseXML/0083jkstn/thumb/jkstn-28-59f9.gif)
Fig. 10.
Overview of liver transplant candidate with hepatocellular carcinoma. Abbreviations: HCC, hepatocellular carcinoma; LD, liver disease.
![jkstn-28-59f10.tif](/upload/SynapseXML/0083jkstn/thumb/jkstn-28-59f10.gif)
Fig. 11.
Liver transplantation rate by hepatocellular carcinoma. Abbreviation: HCC, hepatocellular carcinoma.
![jkstn-28-59f11.tif](/upload/SynapseXML/0083jkstn/thumb/jkstn-28-59f11.gif)
Fig. 12.
Recurrence rate of hepatocellular carcinoma during waiting time. Abbreviation: HCC, hepatocellular carcinoma. a Exclude center No. = 2 due to incomplete date.
![jkstn-28-59f12.tif](/upload/SynapseXML/0083jkstn/thumb/jkstn-28-59f12.gif)
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.
![jkstn-28-59f13.tif](/upload/SynapseXML/0083jkstn/thumb/jkstn-28-59f13.gif)
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 |