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

Kim: Modification of Emergency Status in Deceased Donor Liver Allocation: Evidence for Korean Model of End-stage Liver Disease (MELD) System

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.

REFERENCES

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Fig. 1.
Cut points of MELD score by Survival CART (Classification and regression tree). Abbreviations: MELD, Model for End-stage Liver Disease.
jkstn-30-51f1.tif
Fig. 2.
Survival rate during waiting time by MELD cut points. Abbreviations: MELD, Model for End-stage Liver Disease.
jkstn-30-51f2.tif
Fig. 3.
Cut points of high MELD score by Survival CART (Classification and regression tree). Abbreviations: MELD, Model for End-stage Liver Disease.
jkstn-30-51f3.tif
Fig. 4.
Survival rate during waiting time by MELD cut points in high MELD (>30) candidates. Abbreviations: MELD, Model for End-stage Liver Disease.
jkstn-30-51f4.tif
Fig. 5.
Survival rate during waiting time by tumor stage (within Milan criteria versus above Milan criteria) in patient with hepatocellular carcinoma.
jkstn-30-51f5.tif
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.
jkstn-30-51f6.tif
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.
jkstn-30-51f7.tif
Table 1.
Ratio of liver allocation versus deceased donor recover number by region for recent 10 years
Year Region 1 Region 2 Region 3 Subtotal
2001 163.6% 20.0% 0.0% 105.7%
2002 168.8% 0.0% 11.1% 100.0%
2003 150.0% 0.0% 11.8% 102.0%
2004 128.6% 0.0% 52.6% 100.0%
2005 140.0% 16.7% 52.9% 104.8%
2006 126.4% 33.3% 73.3% 100.9%
2007 132.4% 26.7% 78.8% 104.9%
2008 127.3% 35.5% 61.9% 102.6%
2009 122.1% 41.4% 67.6% 103.1%
2010 129.1% 29.0% 67.4% 104.3%
2011 131.0% 15.2% 83.0% 104.7%
2012 122.8% 43.9% 76.1% 104.0%
2013 140.4% 28.6% 60.8% 105.5%
Means 137.1% 22.3% 53.6% 103.3%
Table 2.
신규 응급도에 따른 권역 내/권역 외(혹은 전국) 배분안
순위 가안 1 가안 2 가안 3 가안 3에 의한 응급도 구분
지역 MELD 점수 지역 MELD 점수 지역 MELD 점수 응급도
1 전국 Status 1 전국 Status 1 전국 Status1 응급도 1
              - MELD 예외
2 권역 MELD 40 권역 MELD 40 권역 MELD 40 응급도 2
3 전국 MELD 40 권역 MELD 39 전국 MELD 40  
4 권역 MELD 39 권역 MELD 38 권역 MELD 39  
5 전국 MELD 39 권역 MELD 37 전국 MELD 39  
6 권역 MELD 38 권역 MELD 36 권역 MELD 38  
7 전국 MELD 38 권역 MELD 35 전국 MELD 38  
8 권역 MELD 37 권역 MELD 34 권역 MELD 37 응급도 3
9 전국 MELD 37 권역 MELD 33 권역 MELD 36  
10 권역 MELD 36 권역 MELD 32 권역 MELD 35  
11 전국 MELD 36 권역 MELD 31 권역 MELD 34  
12 권역 MELD 35 전국 MELD 40 권역 MELD 33  
13 전국 MELD 35 전국 MELD 39 권역 MELD 32  
14 권역 MELD 34 전국 MELD 38 권역 MELD 31  
15 전국 MELD 34 전국 MELD 37 전국 MELD 37  
16 권역 MELD 33 전국 MELD 36 전국 MELD 36  
17 전국 MELD 33 전국 MELD 35 전국 MELD 35  
18 권역 MELD 32 전국 MELD 34 전국 MELD 34  
19 전국 MELD 32 전국 MELD 33 전국 MELD 33  
20 권역 MELD 31 전국 MELD 32 전국 MELD 32  
21 전국 MELD 31 전국 MELD 31 전국 MELD 31  
22 권역 MELD 30∼21 권역 MELD 30∼21 권역 MELD 30∼21 응급도 4
23 전국 MELD 30∼21 전국 MELD 30∼21 전국 MELD 30∼21  
24 권역 MELD ≤20 권역 MELD ≤20 권역 MELD ≤20 응급도 5
25 전국 MELD ≤20 전국 MELD ≤20 전국 MELD ≤20  

Abbreviations: MELD, Model for End-stage Liver Disease.

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