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Development of a Korean Liver Allocation System using Model for End Stage Liver Disease Scores: A Nationwide, Multicenter study

 Juhan Lee  ;  Jae Geun Lee  ;  Inkyung Jung  ;  Dong Jin Joo  ;  Soon Il Kim  ;  Myoung Soo Kim  ;  Advisory Committee on Improving Liver Allocation 
 SCIENTIFIC REPORTS, Vol.9(1) : 7495, 2019 
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The previousKoreanliverallocationsystemwas based on Child-Turcotte-Pughscores, but increasing numbers of deceased donors created a pressing need to develop an equitable, objectiveallocationsystembased onmodelforend-stageliverdiseasescores(MELDscores). Anationwide,multicenter, retrospective cohortstudyof candidates registered forlivertransplantation from January 2009 to December 2011 was conducted at 11 transplant centers. Classification and regression tree (CART) analysis was used to stratify MELD score ranges according to waitlist survival. Of the 2702 patients that registered forlivertransplantation, 2248 chronicliverdiseasepatients were eligible. CART analysis indicated several MELDscoressignificantly predicted waitlist survival. The 90-day waitlist survival rates of patients with MELDscoresof 31-40, 21-30, and ≤20 were 16.2%, 64.1%, and 95.9%, respectively (P < 0.001). Furthermore, the 14-day waitlist survival rates of severely ill patients (MELD 31-40, n = 240) with MELDscoresof 31-37 (n = 140) and 38-40 (n = 100) were 64% and 43.4%, respectively (P = 0.001). Among patients with MELD > 20, presence of HCC did not affect waitlist survival (P = 0.405). Considering the lack of donor organs and geographic disparities in Korea, we proposed the use of a national broader sharing ofliverfor the sickest patients (MELD ≥ 38) to reduce waitlist mortality. HCC patients with MELD ≤ 20 need additional MELD points to allow them equitable access to transplantation. Based on these results, theKoreanNetwork for Organ Sharing implemented the MELDallocationsystemin 2016.
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1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Soon Il(김순일) ORCID logo https://orcid.org/0000-0002-0783-7538
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
Jung, Inkyung(정인경) ORCID logo https://orcid.org/0000-0003-3780-3213
Joo, Dong Jin(주동진) ORCID logo https://orcid.org/0000-0001-8405-1531
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