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Predicted Impact of the Model for End-Stage Liver Disease 3.0 in a Region Suffering Severe Organ Shortage

 Deok-Gie Kim  ;  Seung Hyuk Yim  ;  Eun-Ki Min  ;  Mun Chae Choi  ;  Jae Geun Lee  ;  Myoung Soo Kim  ;  Dong Jin Joo 
 JOURNAL OF KOREAN MEDICAL SCIENCE, Vol.38(35) : e274, 2023-09 
Journal Title
Issue Date
Ascites ; End Stage Liver Disease* / surgery ; Female ; Humans ; Liver Transplantation* ; Living Donors ; Male ; Severity of Illness Index ; Tissue and Organ Procurement*
Allocation ; Liver Transplantation ; MELD ; MELD3.0 ; Waitlist Mortality
Background: The model for end-stage liver disease 3.0 (MELD3.0) is expected to address the flaws of the current allocation system for deceased donor liver transplantation (DDLT). We aimed to validate MELD3.0 in the Korean population where living donor liver transplantation is predominant due to organ shortages.

Methods: Korean large-volume single-centric waitlist data were merged with the Korean Network for Organ Sharing (KONOS) data. The 90-day mortality was compared between MELD and MELD3.0 using the C-index in 2,353 eligible patients registered for liver transplantation. Patient numbers and outcomes were compared based on changes in KONOS-MELD categorization using MELD3.0. Possible gains in MELD points and reduced waitlist mortality were analyzed.

Results: MELD3.0 performed better than MELD (C-index 0.893 for MELD3.0 vs. 0.889 for MELD). When stratified according to the KONOS-MELD categories, 15.9% of the total patients and 35.2% of the deceased patients were up-categorized using MELD3.0 versus MELD categories. The mean gain of MELD points was higher in women (2.6 ± 2.1) than men (2.1 ± 1.9, P < 0.001), and higher in patients with severe ascites (3.3 ± 1.8) than in controls (1.9 ± 1.8, P < 0.001); however, this trend was not significant when the MELD score was higher than 30. When the possible increase in DDLT chance was calculated via up-categorizing using MELD3.0, reducible waitlist mortality was 2.7%.

Conclusion: MELD3.0 could predict better waitlist mortality than MELD; however, the merit for women and patients with severe ascites is uncertain, and reduced waitlist mortality from implementing MELD3.0 is limited in regions suffering from organ shortage, as in Korea.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Deok Gie(김덕기)
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Min, Eun-Ki(민은기)
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
Yim, Seung Hyuk(임승혁) ORCID logo https://orcid.org/0000-0003-2146-3592
Joo, Dong Jin(주동진) ORCID logo https://orcid.org/0000-0001-8405-1531
Choi, Mun Chae(최문채)
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