J Korean Soc Transplant.  2012 Jun;26(2):112-119.

Severity of End-stage Liver Disease in Liver Transplant Candidate; Comparison of KONOS Status with MELD Score

• Joo DJ
• Kim MS
• Kim SI
• Jeon KO
• Huh KH
• Choi GH
• Choi JS

Abstract

BACKGROUND
We have allocated liver according to the Korean Network Organ Sharing (KONOS) status. However, it was necessary to change the system to a more adequate and objective system. We analyzed the correlation between KONOS status and MELD score under the current status of organ allocation.
METHODS
We reviewed medical records of 70 liver recipients as KONOS status 2A and 2B between September 2005 and December 2010. We analyzed their KONOS status, MELD score, clinical characteristics, waiting time, Child-Turcotte-Pugh (CTP) score and clinical symptoms accorded to KONOS status 2A.
RESULTS
Mean MELD and CTP score of the 2A group was significantly higher than the 2B group (P<0.001). In the 2B group, the blood types of all recipients were identical to those of the donors. However, 2A group included 7 cases (23.3%) of non-identical blood types. The MELD score of all recipients were correlated with CTP score (R=0.798, P<0.001). However, there was an overlapping area between the 2B group and the 2A group that was registered by the condition of intractable ascites. Those who had hepatorenal syndrome and hepatic encephalopathy showed high MELD score over 20. However, 36.4% of the patients who had only intractable ascites showed a MELD score of less than 20.
CONCLUSIONS
CTP score was highly correlated with MELD score. However, KONOS status showed some overlapping area of the MELD score between 2A and 2B groups. We should make an effort to improve KONOS allocation system to meet the Korean situation.

Keyword

Liver transplantation; Tissue and organ procurement; Resource allocation; Severity of illness index

MeSH Terms

Ascites
Cytidine Triphosphate
Hepatic Encephalopathy
Hepatorenal Syndrome
Humans
Liver
Liver Diseases
Liver Transplantation
Medical Records
Resource Allocation
Severity of Illness Index
Tissue and Organ Procurement
Tissue Donors
Transplants
Cytidine Triphosphate

Figure

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  Fig. 1 Correlation between MEDL score and CTP score. Correlation analysis, r=0.798 (P<0.0001), Linear regression, R2=0.636 (P<0.0001).

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  Fig. 2 MELD score by pre-transplant KONOS status and inclusion criteria of Status 2A. Abbreviations: HEP, hepatic encephalopathy; HRS, hepatorenal syndrome; Ascites (+), ascites drainage more than 4 L/week; HEP (+), hepatic encephalopathy more than Grade 2; HRS (+), hepatorenal syndrome with serum creatinine≥4 mg/dL or need hemodialysis. aP<0.05 versus Status 2B; bP<0.05 versus Status 2B; cP<0.05 versus Ascites only; dP<0.05 versus HEP (+)/HRS (-).

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  Fig. 3 MELD score distribution by KONOS status with different symptoms. Abbreviations: HEP, hepatic encephalopathy; HRS, hepatorenal syndrome.

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