11/11/2023 0 Comments Meld score 15 prognosis![]() The Korean MELD score-based liver allocation system is based on the following original formula: (9.57×loge +3.78×loge +11.2×loge +6.43). Korean MELD Score-Based Liver Allocation System The study protocol was approved by the institutional review board (IRB No. To avoid unnecessary bias from patient selection, this study included only primary DDLT cases and excluded retransplantation cases who had undergone primary DDLT or living donor liver transplantation (LDLT) before the study period or primary LDLT during the study period. To reflect the real-world situation for DDLT in Korea, the study period for patient selection was set as 42 months between June 2016 and November 2019. To assess the posttransplant prognosis of patients with high MELD scores, three study groups were defined: KONOS status 3 (MELD score 31–37), KONOS status 2 (MELD score 38–40), and MELD-over-40 (MELD >40) groups, without application of a cutoff at 40. This study was a retrospective analysis of DDLT data from the Asan Medical Center. The incidence and prognosis of DDLT recipients with MELD scores >40 were determined through the analysis of the recent DDLT data from a high-volume LT center. ![]() This study aimed to determine whether a MELD score exceeding 40 has any additional prognostic impact on the posttransplant outcomes. However, some patients on the waiting list would progressively deteriorate beyond a MELD score of 40, particularly as a result of organ shortages. The upper limit of the MELD score is intentionally set at a cutoff of 40 for organ allocation in both the United Network for Organ Sharing and the Korean Network for Organ Sharing (KONOS). It also provides an indication of survival outcomes after liver transplantation (LT). The MELD score was originally developed to assess the prognosis of end-stage liver disease patients receiving best supportive care, and was subsequently adopted as a reliable predictor of waiting-list mortality. Although this approach has been successfully applied in patients awaiting DDLT, but the MELD score cutoff for organ allocation is very high, primarily due to a serious shortage of organ donors. This system includes five categories, with status 1 indicating acute liver failure and early graft failure and status 2–5 assigned according to MELD scores. In June 2016, a new Korean liver organ allocation system was implemented, using the model for end-stage liver disease (MELD) score. Optimized allocation of donor organs is a matter of concern for patients on the waiting list for deceased donor liver transplantation (DDLT). Keywords: Deceased donor, Mortality, Waiting list, Ventilator, Marginal graft Retransplantation showed a significant prognostic difference (p40 was not seen to be an independent risk factor.Ĭonclusion: This analysis revealed that very high MELD scores >40 appear to confer additional risk in patients with KONOS status 2 although it was not an independent prognostic factor. Pretransplant ventilator support was associated with inferior patient survival outcomes (p=0.043), but pretransplant renal replacement therapy showed no prognostic significance. The 3-year patient survival was 74.4%, 75.7%, and 52.7% in KONOS status 3, status 2, and MELD-over-40 groups (p=0.19). Overall patient survival was 85.2% at 1 year and 70.7% at 3 years. Graft survival rates of primary DDLT were 84.0% at 1 year and 70.7% at 3 years. Results: During the study period, 168 DDLT operations were performed in 160 patients with KONOS status 3 in 77 (48.1%), status 2 in 65 (40.6%) and MELD-over-40 in 18 (11.3%). Patients were categorized according to Korean Network for Organ Sharing (KONOS) status 3, 2, or MELD-over-40. Methods: Data from adult patients with MELD scores ≥31 who underwent DDLT between June 2016 and November 2019 were retrospectively evaluated. This study investigated prognosis of deceased donor liver transplantation (DDLT) recipients with MELD scores >40. Some patients on waiting list progressed to MELDs >40 due to serious shortage of donor organs. Background: Since 2016, Korean liver organ allocation system has been based on model for end-stage liver disease (MELD).
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