Ann Hepatobiliary Pancreat Surg.  2021 Aug;25(3):336-341. 10.14701/ahbps.2021.25.3.336.

Impact of Model for End-Stage Liver Disease allocation system on outcomes of deceased donor liver transplantation: A single-center experience

• Park HS
• Lee JM
• Hong K
• Han ES
• Hong SK
• Choi Y
• Yi NJ
• Lee KW
• Suh KS

• KMID: 2519289
• DOI: http://doi.org/10.14701/ahbps.2021.25.3.336

Abstract

Backgrounds/Aims
From June of 2016, the Model for End-Stage Liver Disease (MELD)-based allocation system replaced the ChildTurcotte-Pugh (CTP) score-based system for organ allocation liver in Korea. The aim of this study was to analyze changes in outcomes and arising issues before and after the implementation of the MELD system.
Methods
From June 2014 to June 2018, 129 patients were selected from recipients who underwent deceased donor liver transplantation (DDLT) in Seoul National University Hospital. Pediatric cases were excluded. According to the allocation system, patients were divided into two groups (52 in the MELD group and 77 in the CTP group).
Results
MELD scores of the two groups differed significantly (37.8 ± 2.0 in the MELD group vs. 31.0 ± 8.2 in the CTP group; p = 0.001). The etiology of patients was changed for liver transplantation. The proportion of alcoholic liver cirrhosis increased in the era of the MELD allocation system. However, proportions of hepatitis B related liver cirrhosis and hepatocellular carcinoma were decreased. Six-month mortality rate of the MELD group was 25.0%, which was higher than that (11.7%) of the CTP group (p = 0.022). The 90-day complication rate was significantly higher in the MELD group than in the CTP group (11.5% vs. 2.6%; p = 0.040).
Conclusions
When the MELD allocation system was used to distribute livers to severely ill patients, it resulted in poorer outcomes after surgery and higher proportion of alcoholic cirrhosis. Thus, it is necessary to adjust the MELD allocation system so that outcomes after DDLT could be improved.

Keyword

Organ allocation; Liver transplantation; Model for end-stage liver disease

Figure

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  Fig. 1 Changes of etiology between MELD and aCTP based allocation systems. MELD, Model for End-Stage Liver Disease; CTP, Child-Turcotte-Pugh; LC, liver cirrhosis; HBV LC, hepatitis B-related liver cirrhosis; HCV LC, hepatitis C-related liver cirrhosis; PBC, primary biliary cirrhosis; FHF, fulminant hepatic failure; NBNC LC, non-B non-C liver cirrhosis.

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  Fig. 2 Overall 6-month cumulative survival difference between MELD and CTP based allocation groups. MELD, Model for End-Stage Liver Disease; CTP, Child-Turcotte-Pugh.

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  Fig. 3 Overall 90-day complication free survival difference between MELD and CTP based allocation groups. MELD, Model for End-Stage Liver Disease; CTP, Child-Turcotte-Pugh.

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