J Korean Med Sci.  2013 Aug;28(8):1207-1212. 10.3346/jkms.2013.28.8.1207.

The Model for End-Stage Liver Disease Score-Based System Predicts Short Term Mortality Better Than the Current Child-Turcotte-Pugh Score-Based Allocation System during Waiting for Deceased Liver Transplantation

• Hong G
• Lee KW
• Suh S
• Yoo T
• Kim H
• Park MS
• Choi Y
• Yi NJ
• Suh KS

• KMID: 1793027
• DOI: http://doi.org/10.3346/jkms.2013.28.8.1207

Abstract

To adopt the model for end-stage liver disease (MELD) score-based system in Korea, the feasibility should be evaluated by analysis of Korean database. The aim of this study was to investigate the feasibility of the MELD score-based system compared with the current Child-Turcotte-Pugh (CTP) based-system and to suggest adequate cut-off to stratify waiting list mortality among Korean population. We included 788 adult patients listed in waiting list in Seoul National University Hospital from January 2008 to May 2011. The short-term survival until 6 months after registration was evaluated. Two hundred forty six (31.2%) patients underwent live donor liver transplantation and 353 (44.8%) patients were still waiting and 121 (15.4%) patients were dropped out due to death. Significant difference was observed when MELD score 24 and 31 were used as cut-off. Three-months survival of Status 2A was 70.2%. However, in Status 2A patients whose MELD score less than 24 (n=82), 86.6% of patients survived until 6 month. Furthermore, patients with high MELD score (> or =31) among Status 2B group showed poorer survival rate (45.8%, 3-month) than Status 2A group. In conclusion, MELD score-based system can predict short term mortality better and select more number of high risk patients in Korean population.

Keyword

Liver Diseases; Waiting Lists; Survival; Mortality; Liver Transplantation; MELD Score

MeSH Terms

Area Under Curve
Cohort Studies
End Stage Liver Disease/*mortality/therapy
Humans
*Liver Transplantation
*Models, Statistical
ROC Curve
Registries
*Severity of Illness Index
Survival Rate
Time Factors
Waiting Lists

Figure

• 

  Fig. 1 Survival during waiting list according to MELD score at an interval of 5 point (A). C-statistics for 1 month mortality shows that AUC is 0.794 (95% CI, 0.764-0.822; P<0.001) and the cut-off value is 31 (sensitivity, 58.18; specificity, 89.50) (B). C-statistics for 3 month mortality shows that AUC is 0.778 (95% CI, 0.747-0.806, P<0.001) and the cut-off value is 24 (sensitivity, 65.22; specificity, 80.46) (C). The survival curve according to the cut-off values of MELD score for 1, 3 month mortality (D).

• 

  Fig. 2 Survival according to the current KONOS status and MELD subgroups. 3-months survival of Status 2A was 70.2% (A). However, among Status 2A patients, 78 patients with MELD≤24 showed better survival than current Status 2B group (B). Furthermore, patients with high MELD (≥31) among Status 2B group showed poorer survivals (48.2% of 3-month survival) than current Status 2A group (C).

• 

  Fig. 3 Clinical course of the cohorts during 6 months after registration.

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