Modification of Emergency Status in Deceased Donor Liver Allocation: Evidence for Korean Model of End-stage Liver Disease (MELD) System.
10.4285/jkstn.2016.30.2.51
- Author:
Myoung Soo KIM
1
Author Information
1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ysms91@yuhs.ac
- Publication Type:Review
- Keywords:
Liver transplantation;
Waiting lists
- MeSH:
Carcinoma, Hepatocellular;
Emergencies*;
Health Services;
Humans;
Korea;
Liver Diseases*;
Liver Transplantation;
Liver*;
Retrospective Studies;
Tissue Donors*;
Waiting Lists
- From:The Journal of the Korean Society for Transplantation
2016;30(2):51-58
- CountryRepublic of Korea
- Language:Korean
-
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.
