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The Effect of Model for End-Stage Liver Disease 3.0 on Disparities between Patients with and without Hepatocellular Carcinoma in Korea

 Kunhee Kim  ;  Deok-Gie Kim  ;  Jae Geun Lee  ;  Dong Jin Joo  ;  Hye Won Lee 
 YONSEI MEDICAL JOURNAL, Vol.64(11) : 647-657, 2023-11 
Journal Title
Issue Date
Carcinoma, Hepatocellular* / diagnosis ; End Stage Liver Disease* ; Humans ; Liver Neoplasms* / pathology ; Liver Transplantation* ; Republic of Korea ; Retrospective Studies ; Severity of Illness Index
MELD 3.0 ; MELD score ; hepatocellular carcinoma ; liver cirrhosis
Purpose: The model for end-stage liver disease (MELD) 3.0 has recently been suggested for determining liver allocation. We aimed to apply MELD 3.0 to a Korean population and to discover differences between patients with and without hepatocellular carcinoma (HCC).

Materials and methods: This study is a retrospective study of 2203 patients diagnosed with liver cirrhosis at Severance Hospital between 2016-2022. Harrell's concordance index was used to validate the ability of MELD scores to predict 90-day survival.

Results: During a mean follow-up of 12.9 months, 90-day survival was 61.9% in all patients, 50.4% in the HCC patients, and 74.8% in the non-HCC patients. Within the HCC patients, the concordance index for patients on the waitlist was 0.653 using MELD, which increased to 0.753 using MELD 3.0. Among waitlisted patients, the 90-day survival of HCC patients was worse than that of non-HCC patients with MELD scores of 31-37 only (69.7% vs. 30.0%, p=0.001). Applying MELD 3.0, the 90-day survival of HCC patients was worse than that of non-HCC patients across a wider range of MELD 3.0 scores, compared to MELD, with MELD 3.0 scores of 21-30 and 31-37 (82.0% vs. 72.5% and 72.3% vs. 24.3%, p=0.02 and p<0.001, respectively).

Conclusion: MELD 3.0 predicted 90-day survival of the HCC patients more accurately than original MELD score; however, the disparity between HCC and non-HCC patients increased, particularly in patients with MELD scores of 21-30. Therefore, a novel exception score is needed or the current exception score system should be modified.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Deok Gie(김덕기)
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
Lee, Hye Won(이혜원) ORCID logo https://orcid.org/0000-0002-3552-3560
Joo, Dong Jin(주동진) ORCID logo https://orcid.org/0000-0001-8405-1531
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