MELD SCORE 8 LIFE EXPECTANCY REGISTRATION
Therefore, current allocation system does not reflect the risk of early mortality after registration correctly. The risk of mortality in Status 2B group was also relatively low compared with that of intermediate MELD score group ( Fig. However, compared with relatively higher mortality rate in highest MELD score (34.8% of one month mortality in MELD≥31), the one month mortality rate of current Status 2A (12.7%) is too low in contrast to the definition. Because of relatively higher incidence of LDLT in Korea, the mortality could be lower than the United States.
Only 12.7% of patients among Status 2A patients were dead at 1 month after registration and they also showed low mortality rate 29.8%, 33.8% at 3 and 6 months respectively. One month mortality of Status 2A patients was relatively low. This study, however, did not show the early mortality corresponding to the definition. So far, those patients of Status 2A have had priority of deceased donor liver over the patients of other status according to this definition. The definition of KONOS Status 2A is the life expectancy of 1 week or so without LT. Therefore, it is necessary to evaluate the feasibility of MELD system in Korea compared with the current allocation system by analyzing Korean database. Hepatitis B virus (HBV) related liver disease is more prevalent and LDLT is more prevalent.
Medical environment of Korea is somewhat different from the Western. As the DDLT is increasing in Korea, there is an argument that the current allocation system needs to be changed into more objective system such as MELD score-based system. Furthermore, in Status 2B category, non-medical factors such as waiting time and center incentive determined the order of allocation in current Korean allocation system. However, it comprises a couple of subjective factors such as ascites and encephalopathy, therefore, it can be easily manipulated for the purpose of allocation. Current Korean liver allocation system adopted the previous UNOS system, which utilizes CTP score-based system. Keywords: Liver Diseases, Waiting Lists, Survival, Mortality, Liver Transplantation, MELD Scoreĭeceased donor allocation system has not been a major concern in Korea, because LDLT has been prevalent. In conclusion, MELD score-based system can predict short term mortality better and select more number of high risk patients in Korean population. Furthermore, patients with high MELD score (≥31) among Status 2B group showed poorer survival rate (45.8%, 3-month) than Status 2A group. However, in Status 2A patients whose MELD score less than 24 (n=82), 86.6% of patients survived until 6 month. Three-months survival of Status 2A was 70.2%. Significant difference was observed when MELD score 24 and 31 were used as cut-off. Two hundred forty six (31.2%) patients underwent live donor liver transplantation and 353 (44.8%) patients were still waiting and 121 (15.4%) patients were dropped out due to death. The short-term survival until 6 months after registration was evaluated. We included 788 adult patients listed in waiting list in Seoul National University Hospital from January 2008 to May 2011. The aim of this study was to investigate the feasibility of the MELD score-based system compared with the current Child-Turcotte-Pugh (CTP) based-system and to suggest adequate cut-off to stratify waiting list mortality among Korean population. To adopt the model for end-stage liver disease (MELD) score-based system in Korea, the feasibility should be evaluated by analysis of Korean database.
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