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Lee, Choi, Kim, Kwon, and Joh: Comparison Study of Outcomes of Deceased Donor Liver Transplantation before and after Korean Model for End-Stage Liver Disease (MELD) System: Single Center Experience
Original Article

J Korean Soc Transplant 2018;32(1):7-11.

Published online: 19 January 2018

DOI: https://doi.org/10.4285/jkstn.2018.30.1.07

Comparison Study of Outcomes of Deceased Donor Liver Transplantation before and after Korean Model for End-Stage Liver Disease (MELD) System: Single Center Experience

Ji A Lee, M.D., Gyu-seong Choi, M.D., Jong Man Kim, M.D., Chun Hyuck David Kwon, M.D., Jae-Won Joh, M.D.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Corresponding author: Gyu-seong Choi Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: 82-2-3410-0410, Fax: 82-2-3410-1175 E-mail: med9370@gmail.com

Received 17 October 2017       Revised 6 March 2018       Accepted 8 March 2018

Copyright © the Korean Society for Transplantation, 2018

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

Background:

In June of 2016, the Model for End-Stage Liver Disease (MELD)-based allocation system replaced the Child-Turcotte-Pugh (CTP) score-based system for deceased donor liver transplantation (DDLT) in Korea. This study was conducted to reveal the changes before and after the MELD system.

Methods:

From January 2015 to March 2017, 71 patient datapoints were collected from recipients who underwent DDLT in a single center. Patients were divided into two groups according to the allocation system (41 in the MELD group, 30 in the CTP group).

Results:

The MELD score of the two groups differed significantly (36.8±4.5 in the MELD group, 26.0±8.1 in the CTP group, P=0.001). There was no difference in etiology for liver transplantation, 6-month survival rate, or in-hospital stay. However, complication rate and re-admission rate within the first 3 months were higher in the MELD group (78%, 56%). No one received a DDLT because of an incentive system for hepatocellular carcinoma.

Conclusions:

Despite the short-term follow-up period, the new allocation rule reflects the severity of the patients. Almost all patients who underwent DDLT when they had a high MELD score and then suffered from morbidity; however, this problem was associated with organ shortage, not the allocation system.

Keywords: Liver transplantation, Model for End-Stage Liver Disease, Allocation

REFERENCES

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Fig. 1.
Six month-survival curve of two groups. Dashed line is a Model for End-Stage Liver Disease (MELD) group, and dot line a Child-Turcotte-Pugh (CTP) groups. No difference between two groups was shown statistically (MELD group 82.9%, CTP group 80.8%, P=0.338).
jkstn-32-7f1.tif
Table 1.
Demographic finding of two groups
Variable MELD group (n=41) CTP group (n=30) P-value
Recipient's age (yr) 51.4±11.2 54.7±10.0 0.209
Recipient's sex (male:female) 30:11 22:8 0.988
Recipients’ blood type (A:B:O:AB) 14:9:11:7 11:6:7:6 NS
Donor's age (yr) 49.3±15.8 53.9±15.7 0.231
Donor's sex (male:female) 28:23 16:14 0.205
Donors’ blood type (A:B:O:AB) 14:6:15:5 11:7:7:5 NS
MELD score 36.8±4.5 26.0±8.1 ＜0.001
CTP score 11.5±1.25 10.9±1.7 NS
Primary disease
  Fulminant hepatic failure 1 3  
  Primary non-function 2 2  
  HBV-related 11 7  
  HCV-related 3 3  
  Alcohol-related 19 12  
  Others 5 3  

Data are presented as mean±SD or number. Abbreviations: MELD, Model for End-Stage Liver Disease; CTP, Child-Turcotte-Pugh; NS, not significant; HBV, hepatitis B virus; HCV, hepatitis C virus.

Table 2.
Outcomes of two groups
Variable MELD group (n=41) CTP group (n=30) P-value
6 Months survival (%) 82.9±0.06 80.0±0.07 0.338
3 Months complication 32/41 (78) 16/30 (53.3) 0.026
3 Months re-admission 23/41 (56) 10/30 (33.3) 0.048
In-hospital stay (day) 32.4±23.8 42.0±79.4 0.438

Data are presented as mean±SD or number (%).

Abbreviations: MELD, Model for End-Stage Liver Disease; CTP, Child-Turcotte-Pugh.

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