Impact of Model for End-Stage Liver Disease Score Based Allocation System in Korea = Impact of Model for End-Stage Liver Disease Score Based Allocation System in Korea

다국어 초록 (Multilingual Abstract)

Aims: In June of 2016, the Korean Network for Organ Sharing implemented 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 MELD based allocation system.
Methods: We compared waitlist and post-transplant outcomes in the first 4 months of MELD allocation system (from June to September, 2016) to an equivalent time period before (from February to May, 2016).
Results: A total of 1114 candidates were listed (510 pre-MELD, 604 post-MELD) and 340 patients (156 pre-MELD, 184 post-MELD) received DDLT during the study period. As expected, introduction of MELD allocation system increased mean MELD score at transplant (24.6 ± 8.6 pre-MELD, 35.0 ± 6.1 post-MELD, P<0.001). Although overall transplant rates remained similar between pre-MELD and MELD era, the transplant rate significantly increased for candidates with high MELD score (MELD ≥31) in MELD era. The proportion of inter- regional shift increased from 28.8% to 44.0%. Post-transplant patient survival rate was 85.6% before and 83.1% after MELD implementation (P=0.537). There was no significant correlation between MELD scores at transplant and post-transplant survival. Significant transplant survival benefit was observed at MELD scores of ≥20 compared to candidates on the waitlist, and the magnitude of transplant benefit increased with increasing MELD score.
Conclusions: The MELD system addresses the goal of fairness well. The implementation of the MELD system was associated with reduction in geographic disparities. Although sicker patients received liver transplantation in the MELD era, post-transplant survival was similar in both periods.