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

Abstract

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.