Ann Liver Transplant.  2021 May;1(1):10-17. 10.52604/alt.21.0003.

Absence of influence of the Korean MELD score-based liver allocation system on pretransplant MELD score in patients undergoing living donor liver transplantation

• Kim SH
• Hwang S
• Ahn CS
• Moon DB
• Ha TY
• Song GW
• Jung DH
• Park GC
• Kim KH
• Yoon YI
• Kang WH
• Cho HD
• Kim M
• Na BG
• Kim SM
• Yang G
• Lee SG

• KMID: 2560848
• DOI: http://doi.org/10.52604/alt.21.0003

Abstract

Background
Model for end-stage liver disease (MELD) score-based allocation system was started in 2016 in Korea. This study aimed to analyze the profiles of adult patients who underwent living donor liver transplantation (LDLT) in the pre- and post-MELD eras.
Methods
This study was a retrospective double-arm analysis using a single-institution LDLT cohort. We compared the LDLT recipient profiles by focusing on pretransplant MELD score for 4 years before and after the introduction of the MELD scorebased allocation system. Patients without and with hepatocellular carcinoma (HCC) were categorized as Group A and B in the pre-MELD era and Group C and D in the post-MELD era, respectively.
Results
The number of patients in Groups A, B, C and D was 615, 599, 704 and 713, respectively; and their MELD scores were 19.0±9.4, 11.2±5.6, 17.9±8.5 and 11.6±5.7, respectively. Clinical parameters of liver cirrhosis indicate that Group A had worse general conditions than Group C; and Groups B and D had similar general conditions. The comparative analysis between Groups A and C revealed the mean and median MELD scores as 19.0±9.4 and 17.9±8.5 (p=0.009), and 16 and 15 (p=0.077), respectively. The comparative analysis between Groups B and D revealed the mean and median MELD scores as 11.2±5.6 and 11.6±5.7 (p=0.14), and 9 and 9 (p=0.14), respectively.
Conclusion
Median pretransplant MELD score was in the range of 15-16 in LDLT recipients without HCC and 9 in those with HCC. Introduction of MELD score in deceased donor organ allocation system resulted in a marginal decrease in the pretransplant MELD score in patients undergoing LDLT without HCC, but no change in those with HCC.

Keyword

MELD score; Hepatocellular carcinoma; Living donor; Deceased donor; Organ allocation

Figure

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  Figure 1 Comparison of the model for end-stage liver disease (MELD) score level in adult living donor liver transplantation recipients. Groups A and B indicate patients without and with hepatocellular carcinoma (HCC) respectively in the pre-MELD era. Groups C and D indicate patients without and with HCC respectively in the post-MELD era.

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  Figure 2 Comparison of the model for end-stage liver disease (MELD) score level in adult living donor liver transplantation recipients. (A) Comparison of the patients without hepatocellular carcinoma (HCC) in the pre-MELD (Group A) and post-MELD (Group C) eras. (B) Comparison of the patients with HCC in the pre-MELD (Group B) and post-MELD (Group D) eras.

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  Figure 3 Comparison of the model for end-stage liver disease score (MELD) level according to the Korean Network for Organ Sharing (KONOS) and grouping with the timing of liver transplantation and the status of hepatocellular carcinoma (HCC). (A) Comparison of the incidence of the KONOS status according to the groups. (B) Comparison of the proportion of the KONOS status according to the groups. Groups A and B indicate patients without and with HCC respectively in the pre-MELD era. Groups C and D indicate patients without and with HCC respectively in the post-MELD era.

Reference

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