Journal List > J Korean Soc Transplant > v.30(2) > 1034504

J Korean Soc Transplant. 2016 Jun;30(2):51-58. Korean.
Published online June 30, 2016.  https://doi.org/10.4285/jkstn.2016.30.2.51
Copyright © 2016 The Korean Society for Transplantation
Modification of Emergency Status in Deceased Donor Liver Allocation: Evidence for Korean Model of End-stage Liver Disease (MELD) System
Myoung Soo Kim, M.D.1,2
1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
2The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Myoung Soo Kim. Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: 82-2-2228-2123, Fax: 82-2-313-8289, Email: ysms91@yuhs.ac
Received June 10, 2016; Revised June 15, 2016; Accepted June 15, 2016.

Abstract

For a more useful and objective allocation system, we considered the Model for End-stage Liver Disease (MELD) system as an alternative to the Child-Turcotte-Pugh (CTP) score and status system in Korea. Development of basic assessment measures based on the Korean health service environment is the objective of this study. The data collected from a series of liver transplant candidates (n=2,702, 2009~2012) were used as raw data for statistical analysis for this study. Using MELD score cut-points at 20, 30, 38 points, we observed significant survival difference by step-wise survival analysis. Emergency status 2 (38~40 points) and status 3 (31~37 points) were classified as urgent status for liver allocation. In such classes, early national-based allocation is possible. Patients with hepatocellular carcinoma (HCC) with low MELD scores (<20 point) are given an additional MELD score (+4 or +5 MELD score). This study helps advance the development of basic systematic rules for liver allocation. The rules for management of registration and re-registration of status, registration interval, validity and treatment rule of non-registered cases are defined. Through analysis of Korean retrospective records, this study proposed basic rules of liver allocation and a systematic proposal for the MELD system, which has been in use since June 2016.

Keywords: Liver transplantation; Waiting lists

Figures


Fig. 1
Cut points of MELD score by Survival CART (Classification and regression tree). Abbreviations: MELD, Model for End-stage Liver Disease.
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Fig. 2
Survival rate during waiting time by MELD cut points. Abbreviations: MELD, Model for End-stage Liver Disease.
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Fig. 3
Cut points of high MELD score by Survival CART (Classification and regression tree). Abbreviations: MELD, Model for End-stage Liver Disease.
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Fig. 4
Survival rate during waiting time by MELD cut points in high MELD (>30) candidates. Abbreviations: MELD, Model for End-stage Liver Disease.
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Fig. 5
Survival rate during waiting time by tumor stage (within Milan criteria versus above Milan criteria) in patient with hepatocellular carcinoma.
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Fig. 6
Survival rate of candidates with hepatocellular carcinoma (HCC) (MELD score range: 0~13) was similar with those of candidates without HCC (MELD score range: 14~17). Abbreviations: MELD, Model for End-stage Liver Disease; HCC, Hepatocellular carcinoma.
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Fig. 7
Survival rate of candidates with hepatocellular carcinoma (HCC) (MELD score range: 14~20) was similar with those of candidates without HCC (MELD score range: 21~25). Abbreviations: MELD, Model for End-stage Liver Disease; HCC, Hepatocellular carcinoma.
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Tables


Table 1
Ratio of liver allocation versus deceased donor recovery number by region for recent 10 years
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Table 2
신규 응급도에 따른 권역 내/권역 외(혹은 전국) 배분안
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