BACKGROUND: In June of 2016, the Model for End-Stage Liver Disease (MELD)-based allocation system replaced the Child-Turcotte-Pugh (CTP) score-based system for deceased donor liver transplantation (DDLT) in Korea. This study was conducted to reveal the changes before and after the MELD system. METHODS: From January 2015 to March 2017, 71 patient datapoints were collected from recipients who underwent DDLT in a single center. Patients were divided into two groups according to the allocation system (41 in the MELD group, 30 in the CTP group). RESULTS: The MELD score of the two groups differed significantly (36.8±4.5 in the MELD group, 26.0±8.1 in the CTP group, P=0.001). There was no difference in etiology for liver transplantation, 6-month survival rate, or in-hospital stay. However, complication rate and re-admission rate within the first 3 months were higher in the MELD group (78%, 56%). No one received a DDLT because of an incentive system for hepatocellular carcinoma. CONCLUSIONS: Despite the short-term follow-up period, the new allocation rule reflects the severity of the patients. Almost all patients who underwent DDLT when they had a high MELD score and then suffered from morbidity; however, this problem was associated with organ shortage, not the allocation system.
Carcinoma, Hepatocellular ; Cytidine Triphosphate ; Follow-Up Studies ; Humans ; Korea ; Liver Diseases* ; Liver Transplantation* ; Liver* ; Motivation ; Survival Rate ; Tissue Donors*

BACKGROUND/AIMS: Human hepatocellular carcinoma (HCC) is a hypervascular tumor, and vascular endothelial growth factor (VEGF) plays a key role in the regulation of tumor-associated angiogenesis. In this study, we analyzed the significance of the expression of VEGF family members on the prognosis and clinicopathologic progress of HCC. METHODS: Surgically resected specimens of HCC and noncancerous liver tissue were obtained from 323 patients with HCC, and VEGF mRNA was examined by quantitative reverse transcriptase-polymerase chain reactions (RT-PCRs). Patients who were seropositive for hepatitis B surface antigen were selected for the analysis (n=208). The VEGF(tumor)/GAPDH (glyceraldehyde-3-phosphate dehydrogenase)(tumor)/VEGF(nontumor)/GAPDH(nontumor) ratio was calculated using a quantitative RT-PCR assay, and the relationships between the expressions of VEGF family members and clinicopathologic parameters were analyzed to evaluate their significance in the prognosis of HCC. RESULTS: The disease-free survival was significantly worse in the high-VEGF-A group than in the low-VEGF-A group (P=0.035), whereas VEGF-A expression was not significantly related to overall survival (P=0.172). The factors significantly related to poor prognosis in univariate analysis were tumor size, portal vein invasion, microvascular thrombi, intrahepatic metastasis, tumor capsule invasion, liver capsule invasion, preoperative serum albumin level, and VEGF-A ratio. Multivariate analysis showed that a poor prognosis in HCC patients was significantly related to portal vein invasion (hazard ratio=3.381, P<0.001), intrahepatic metastasis (hazard ratio=2.379, P<0.001), tumor size (hazard ratio=1.834, P=0.003), and preoperative serum albumin level (hazard ratio=2.050, P=0.006). CONCLUSIONS: Our study showed that the expression of VEGF-A is positively correlated with the recurrence rate of HCC after curative resection. Therefore, a high expression of VEGF-A might be predictive of HCC recurrence after curative resection.
Adult ; Aged ; Base Sequence ; Carcinoma, Hepatocellular/*diagnosis/*surgery/virology ; Female ; Hepatitis B/complications ; Hepatitis B Surface Antigens/blood ; Humans ; Liver Neoplasms/*diagnosis/*surgery/virology ; Male ; Middle Aged ; Molecular Sequence Data ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Staging ; Predictive Value of Tests ; Prognosis ; RNA, Messenger/analysis ; Reverse Transcriptase Polymerase Chain Reaction ; Survival Analysis ; Vascular Endothelial Growth Factors/genetics/*metabolism

BACKGROUND: The influence of lymphocytotoxic cross-match results on acute cellular rejection in adult living donor liver transplantation (LDLT) has not been well examined. Therefore, in this study, we investigated the risk factors of acute rejection, including positive lymphocytotoxic cross-match results. METHODS: Patients inquired in this study are adults who underwent their first LDLT between June 1997 and June 2007 (n=382). We reviewed retrospectively the medical records of donors and recipients, including medical history, surgical procedures, and progress, then analyzed the risk factors of acute rejection using Cox's proportion hazard model. RESULTS: Among the total subjects of 382, 32 recipients had positive lymphocytotoxic cross-match results. Median follow-up duration was 28.0 months (range, 1~93). Fifty six recipients had suffered at least one or more acute rejection episodes. In univariate analysis, positive lymphocytotoxic cross-match results didn't turn out to be a significant risk factor of acute rejection (p=0.735), while recipient age (P=0.012), HCV-related (P=0.001), MELD score (P=0.042), gender mismatch (P=0.001) and no induction of anti-IL-2 receptor antibody (P=0.034) were revealed as risk factors for acute rejection. Recipient age (P=0.001, Hazard Ratio 0.937, 95% Confidence Interval 0.902~0.973), gender mismatch (P=0.001, Hazard Ratio 2.970, 95% Confidence Interval 1.524~5.788), HCV-related (P=0.001, Hazard Ratio 4.313, 95% Confidence Interval 1.786~10.417) were considered as significant risk factors in multivariate analysis. CONCLUSIONS: Positive lymphocytotoxic cross-match results may not be the risk factor for acute rejection. Therefore, it should not be considered as a determinant when matching donors with recipients in adult LDLT.
Adult ; Follow-Up Studies ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Medical Records ; Rejection (Psychology) ; Retrospective Studies ; Risk Factors ; Tissue Donors