J Korean Soc Transplant.  2016 Jun;30(2):51-58. 10.4285/jkstn.2016.30.2.51.

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

Affiliations
  • 1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ysms91@yuhs.ac
  • 2The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.

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.

Keyword

Liver transplantation; Waiting lists
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