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Impact of Model for End-stage Liver Disease Score-based Allocation System in Korea

A Nationwide Study

Lee, Juhan MD1; Kim, Deok Gie MD1; Lee, Jee Youn MD1; Lee, Jae Geun MD1; Joo, Dong Jin MD, PhD1; Kim, Soon Il MD, PhD1; Kim, Myoung Soo MD, PhD1

doi: 10.1097/TP.0000000000002755
Original Clinical Science—Liver
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Background. In June 2016, the Korean Network for Organ Sharing implemented a Model for End-stage Liver Disease (MELD) score-based allocation system to better prioritize deceased-donor liver transplant (DDLT) candidates. The aim of this study was to assess the impact of this allocation system.

Methods. We compared waiting list and posttransplant outcomes during the first year of operation of the MELD allocation system (from June 2016 to May 2017) with an equivalent period before its implementation (from June 2015 to May 2016).

Results. A total of 3041 candidates were listed for DDLT (1464 pre-MELD, 1577 post-MELD era) and 892 patients received DDLT during the study period. A decrease in waiting list mortality and an increase in DDLT rate were observed after MELD implementation. However, the number of living donor liver transplants did not differ significantly pre- to post-MELD. As was expected, introduction of the MELD allocation system increased mean MELD scores at DDLT (24.1 ± 8.3 pre-MELD, 34.5 ± 7.0 post-MELD era, P < 0.001). Posttransplant patient survival rates at 1-year were 79.9% in pre-MELD era and 76.2% in post-MELD era (P = 0.184). The proportion of interregional organ transfer increased from 25.1% to 40.5%. Furthermore, transplant benefits increased with MELD scores.

Conclusions. The MELD system was found to address the goal of fairness well. Implementation of the MELD system improved equity in terms of access to DDLT regardless of regions. Although a greater proportion of more severely ill patients received DDLT after MELD implementation, posttransplant survivals remained unchanged.

1 Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.

Received 21 September 2018. Revision received 12 March 2019.

Accepted 25 March 2019.

J.L. and M.S.K. designed the study. D.G.K., J.Y.L., and J.G.L. participated in data analysis. J.L. participated in the writing of the paper. D.J.J., S.I.K., and M.S.K. critically revised the article for important intellectual content.

The authors declare no conflict of interest.

This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (2016-P82001-00).

Oral presentation at the International Society for Organ Donation and Procurement in Geneva, Switzerland, September 6–9, 2017.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence to Myoung Soo Kim, MD, PhD, Department of Surgery, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. (ysms91@yuhs.ac).

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