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

Myoung Soo Kim

doi:10.4285/jkstn.2016.30.1.51

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

Review Article

J Korean Soc Transplant 2016;30(2):51-58.

Published online: 19 January 2016

DOI: https://doi.org/10.4285/jkstn.2016.30.1.51

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 E-mail: ysms91@yuhs.ac

Received 10 June 2016 Revised 15 June 2016 Accepted 15 June 2016

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

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

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.

Fig. 2.

Survival rate during waiting time by MELD cut points. Abbreviations: MELD, Model for End-stage Liver Disease.

Fig. 3.

Cut points of high MELD score by Survival CART (Classification and regression tree). Abbreviations: MELD, Model for End-stage Liver Disease.

Fig. 4.

Survival rate during waiting time by MELD cut points in high MELD (＞30) candidates. Abbreviations: MELD, Model for End-stage Liver Disease.

Fig. 5.

Survival rate during waiting time by tumor stage (within Milan criteria versus above Milan criteria) in patient with hepatocellular carcinoma.

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.

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.

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
순위	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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