Ha Hea-Seon, Hong Jung-Ja, Kim In-Ok, Lee Sae-Rom, Lee Ah-Young, Ha Tae-Yong, Song Gi-Won, Jung Dong-Hwan, Park Gil-Chun, Ahn Chul-Soo, Moon Deok-Bog, Kim Ki-Hun, Lee Sung-Gyu, Hwang Shin
Organ Transplantation Center, Asan Medical Center, Seoul, Korea.
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Transplant. 2019 Dec 31;33(4):112-117. doi: 10.4285/jkstn.2019.33.4.112.
The Korean model for end-stage liver disease (MELD) score-based liver allocation system was started in June 2016 in Korea.
This study analyzed the detailed allocation results of deceased donor liver transplantation (DDLT) during the first 2 years after the MELD score-based liver allocation system implementation at a high-volume liver transplantation (LT) center in Korea.
This study included 174 patients with age above 12 years. The patient ABO blood groups were A (n=65, 37.4%), B (n=51, 29.3%), O (n=28, 16.1%), and AB (n=30, 17.2%). The LT types were primary LT in 141 patients (81.0%) and retransplantation in 33 (19.0%). The Korean Network for Organ Sharing status categories at LT were as follows: status 1 (n=11, 6.3%), status 2 (n=82, 47.1%), status 3 (n=63, 36.2%), and status 4 (n=18, 10.3%). The mean MELD score at LT and waiting period were 36.6±4.6 and 62.1±98.2 days in blood group A; 37.6±3.6 and 25.7±38.1 days in blood group B; 38.8±2.7 and 26.0±30.5 days in blood group O; and 34.8±5.5 and 68.4±110.5 days in blood group AB (P<0.001 and P=0.012), respectively. Patients with blood group O and AB had the highest and lowest mean MELD scores at LT allocation, respectively.
Serious deceased organ donor shortage resulted in very high MELD score cutoffs for DDLT allocation. Additionally, a significant inequality was observed in the possibility for DDLT according to blood group compatibility. Nationwide follow-up studies are necessary to precisely determine the allocation status of DDLT.
基于韩国终末期肝病模型（MELD）评分的肝脏分配系统于2016年6月在韩国启动。
本研究分析了韩国一家大型肝脏移植（LT）中心在基于MELD评分的肝脏分配系统实施后的头2年期间尸体供肝移植（DDLT）的详细分配结果。
本研究纳入了174例年龄在12岁以上的患者。患者的ABO血型为A型（n = 65，37.4%）、B型（n = 51，29.3%）、O型（n = 28，16.1%）和AB型（n = 30，17.2%）。LT类型为初次LT 141例（81.0%），再次移植33例（19.0%）。LT时韩国器官共享网络状态分类如下：1类（n = 11，6.3%）、2类（n = 82，47.1%）、3类（n = 63，36.2%）和4类（n = 18，10.3%）。A型血患者LT时的平均MELD评分和等待期分别为36.6±4.6和62.1±98.2天；B型血患者为37.6±3.6和25.7±38.1天；O型血患者为38.8±2.7和26.0±30.5天；AB型血患者为34.8±5.5和68.4±110.5天（P<0.001和P = 0.012）。O型血和AB型血患者在LT分配时的平均MELD评分分别最高和最低。
严重的尸体器官供体短缺导致DDLT分配的MELD评分临界值非常高。此外，根据血型相容性观察到DDLT可能性存在显著不平等。有必要进行全国性的随访研究以精确确定DDLT的分配状况。
