Development of Korean Liver Allocation System Based on Model for End Stage Liver Disease Score: A Nationwide, Multicenter Study

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Abstract

Background

Current Korean liver allocation system is based on Child-Turcotte-Pugh score. As the number of deceased donor has been increased, there is a pressing need to develop equitable and objective allocation system based on model for end-stage liver disease score (MELD score).

Methods

We conducted a nationwide, multicenter, retrospective cohort study of candidates who were listed for liver transplantation from January 2009 to December 2011 at 11 transplant centers. Classification and regression tree (CART) analysis was used to stratify MELD score ranges according to the waitlist removal.

Results

Among 2702 patients listed for liver transplantation, 2453 chronic liver disease patients were eligible. Of the patients, 1068 patients (47.6%) were with hepatocellular carcinoma (HCC). The CART analysis indicated several MELD scores for the significant determinant points for the waitlist removal. The 90-day waitlist survival rates were 16.2% for MELD 31-40, 64.1% for MELD 21-30, and 95.9% for MELD ≤20, respectively (P<0.001). We further partitioned severely ill patients (MELD 31-40, n=240) into subgroups according to 14-day waitlist removal. The 14-day waitlist survival rates were 61.5% for patients with MELD 31-37 and 41.6% for those with MELD 38-40 (P=0.003). In patients with MELD >20, the presence of HCC did not affect the waitlist removal. We determined MELD ranges for HCC patients with waitlist removal rates equivalent to those of non-HCC patients (HCC MELD 14-20 vs. non-HCC MELD 21-25; HCC MELD <14 vs. non-HCC MELD 14-17).

Conclusion

MELD score successfully discriminates Korean waitlist patients according to short-term mortality. Considering lack of donor organs and geographic disparities in Korea, we suggest staged broader sharing model based on survival CART analysis. In HCC prevalent area, prioritization within HCC candidates on the basis of native MELD score is required.

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