Takemura Yusuke, Ueda Yoshihide, Takemura Ryo, Mita Junya, Ashikari Juntaro, Kuramitsu Kaori, Hasegawa Yasushi, Kitago Minoru, Obara Hideaki, Kitagawa Yuko, Ohdan Hideki, Yokota Hiroyuki
Division of Investigation and Research, Japan Organ Transplant Network, 3-26-1 Kaigan, Minato-ku, Tokyo, 108-0022, Japan.
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
J Gastroenterol. 2025 Aug 14. doi: 10.1007/s00535-025-02288-y.
In Japan's deceased-donor liver transplantation (DDLT), a new allocation policy based on the Model for End-Stage Liver Disease (MELD) score, including the exceptional MELD system (Ex-MELD), which periodically assigns additional points to the basal MELD score, was implemented in May 2019. We assessed the current state of this system for adult candidates with chronic end-stage liver disease.
Adult candidates (≥ 18 years) registered in the Japan Organ Transplant Network for DDLT as Status 2 cases (including chronic end-stage liver disease patients) between May 2019 and April 2023 were evaluated. We divided them into the MELD, Ex-MELD (major) [start 16 points, 2 points by 180 days], and Ex-MELD [hepatocellular carcinoma (HCC)] groups. Transplant probability and waitlist mortality rates were compared using competing risk analyses. The annual proportion of DDLT and the transition of median MELD at transplantation were also investigated.
There were 757 candidates in MELD,126 in Ex-MELD (major), and 99 in Ex-MELD (HCC) groups. The transplant probability rates were not significantly different (3-year transplant probability rate; MELD: 24.0% vs. Ex-MELD (major): 21.0% vs. Ex-MELD (HCC): 24.1%). The rate in the Ex-MELD (major) increased dramatically as the waiting period lengthened. The waitlist mortality rates in the Ex-MELD (major) group were significantly lower (3-year waitlist mortality rate; MELD: 50.5% vs. Ex-MELD (major): 25.0% vs. Ex-MELD (HCC): 57.0%). Although the proportion of Ex-MELD (major) increased yearly in the transplanted cases, the median MELD at transplantation did not change significantly.
We clearly showed the current status of adult Status 2 candidates.
在日本的尸体供肝肝移植（DDLT）中，基于终末期肝病模型（MELD）评分的新分配政策于2019年5月实施，其中包括特殊MELD系统（Ex-MELD），该系统会定期给基础MELD评分额外加分。我们评估了该系统用于成年慢性终末期肝病候选者的现状。
对2019年5月至2023年4月期间在日本器官移植网络中登记为2类状态（包括慢性终末期肝病患者）的成年DDLT候选者（≥18岁）进行评估。我们将他们分为MELD组、Ex-MELD（主要）组[起始16分，每180天加2分]和Ex-MELD[肝细胞癌（HCC）]组。使用竞争风险分析比较移植概率和等待名单死亡率。还调查了DDLT的年度比例以及移植时MELD中位数的变化。
MELD组有757名候选者，Ex-MELD（主要）组有126名，Ex-MELD（HCC）组有99名。移植概率率无显著差异（3年移植概率率；MELD组：24.0%，Ex-MELD（主要）组：21.0%，Ex-MELD（HCC）组：24.1%）。Ex-MELD（主要）组的概率率随着等待期延长而显著增加。Ex-MELD（主要）组的等待名单死亡率显著更低（3年等待名单死亡率；MELD组：50.5%，Ex-MELD（主要）组：25.0%，Ex-MELD（HCC）组：57.0%）。尽管Ex-MELD（主要）组在移植病例中的比例逐年增加，但移植时的MELD中位数没有显著变化。
我们清楚地展示了成年2类状态候选者的现状。
