J Korean Soc Transplant.  2014 Jun;28(2):59-68. 10.4285/jkstn.2014.28.2.59.

Research for Modification of Emergency Status in Deceased Donor Liver Allocation: Survival Analysis of Waiting Patients for Liver Transplantation

• Kim MS
• Lee KW
• Hwang S
• Kwon CH
• You YK
• Nah YW
• Yu HC
• Kim DS
• Wang HJ
• Choi DL
• Choi IS
• Kim SI

• KMID: 2202532
• DOI: http://doi.org/10.4285/jkstn.2014.28.2.59

Abstract

Despite a remarkable increase of deceased donors, organ shortage is the main hurdle of organ transplantation in Korea. Therefore, liver transplantation priority is a major issue of liver allocation. We confront a situation that needs to change in order to achieve more adequate and objective allocation of the system. We considered the MELD system as an alternative to the CTP score and Status system. For application of the MELD system, comparison between two systems is required; and a national-based retrospective review of liver transplantation candidates (waiting list) was conducted as a multi-center collaborative study. Eleven transplant centers participated in this national study. From 2009 to 2012, 2,702 waiting lists were enrolled. After mean 349+/-412 days follow-up, 967 patients (35.8%) of liver transplantation, 750 patients (27.8%) of drop-out/mortality, and 719 patients (26.6%) on waiting were identified. In analysis of patient mortality during waiting time, status system showed significant difference of waiting mortality by status at registration. However, differences of waiting mortality by MELD system were more prominent and discriminate. In comparisons by MELD score in exclusive Status 2A waiting patients, there was a significant difference of waiting mortality by MELD score. This means that the MELD system is a good predictor of short-term survival after listing compared with status system with CTP score. Korean national-based retrospective study showed the superiority of the MELD system in prediction of short-term mortality and usefulness as a determinant for allocation priority.

Keyword

Resource allocation; Liver transplantation; End stage liver disease

MeSH Terms

Cytidine Triphosphate
Emergencies*
End Stage Liver Disease
Follow-Up Studies
Humans
Korea
Liver Transplantation*
Liver*
Mortality
Organ Transplantation
Resource Allocation
Retrospective Studies
Survival Analysis*
Tissue Donors*
Transplants
Waiting Lists
Cytidine Triphosphate

Figure

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  Fig. 1. Overview of liver transplant candidate (waiting list). Abbreviations: HCC, hepatocellular carcinoma.

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  Fig. 2. Overall liver transplantation rate after registration by status.

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  Fig. 3. Deceased donor liver transplantation rate after registration by status.

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  Fig. 4. Living donor liver transplantation rate after registration by status.

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  Fig. 5. Waiting list survival rate after registration by status.

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  Fig. 6. Waiting list survival rate after registration by MELD score. Abbreviation: MELD, model for end-stage liver disease.

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  Fig. 7. Waiting list survival rate after registration by MELD score in Status 2A. Abbreviation: MELD, model for end-stage liver disease.

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  Fig. 8. Waiting list survival rate after registration by MELD score in Status 2B. Abbreviation: MELD, model for end-stage liver disease.

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  Fig. 9. Waiting list survival rate after registration by MELD score in Status 3. Abbreviation: MELD, model for end-stage liver disease.

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  Fig. 10. Overview of liver transplant candidate with hepatocellular carcinoma. Abbreviations: HCC, hepatocellular carcinoma; LD, liver disease.

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  Fig. 11. Liver transplantation rate by hepatocellular carcinoma. Abbreviation: HCC, hepatocellular carcinoma.

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  Fig. 12. Recurrence rate of hepatocellular carcinoma during waiting time. Abbreviation: HCC, hepatocellular carcinoma. a Exclude center No. = 2 due to incomplete date.

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  Fig. 13. Different effects of MELD score on waiting list survival rate by hepatocellular carcinoma. Abbreviations: MELD, model for end-stage liver disease; HCC, hepatocellular carcinoma.

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  Fig. 14. Liver transplantation rate after registration.

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  Fig. 15. Yearly census of liver transplantation in Korea. Abbreviation: DD, deceased donor.

Reference

References

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