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. 2023 Sep 4;38(35):e274.
doi: 10.3346/jkms.2023.38.e274.

Predicted Impact of the Model for End-Stage Liver Disease 3.0 in a Region Suffering Severe Organ Shortage

Deok-Gie Kim  1 , Seung Hyuk Yim  1 , Eun-Ki Min  1 , Mun Chae Choi  1 , Jae Geun Lee  1 , Myoung Soo Kim  1 , Dong Jin Joo  2
Affiliations

Predicted Impact of the Model for End-Stage Liver Disease 3.0 in a Region Suffering Severe Organ Shortage

Deok-Gie Kim et al. J Korean Med Sci. .

Abstract

Background: The model for end-stage liver disease 3.0 (MELD3.0) is expected to address the flaws of the current allocation system for deceased donor liver transplantation (DDLT). We aimed to validate MELD3.0 in the Korean population where living donor liver transplantation is predominant due to organ shortages.

Methods: Korean large-volume single-centric waitlist data were merged with the Korean Network for Organ Sharing (KONOS) data. The 90-day mortality was compared between MELD and MELD3.0 using the C-index in 2,353 eligible patients registered for liver transplantation. Patient numbers and outcomes were compared based on changes in KONOS-MELD categorization using MELD3.0. Possible gains in MELD points and reduced waitlist mortality were analyzed.

Results: MELD3.0 performed better than MELD (C-index 0.893 for MELD3.0 vs. 0.889 for MELD). When stratified according to the KONOS-MELD categories, 15.9% of the total patients and 35.2% of the deceased patients were up-categorized using MELD3.0 versus MELD categories. The mean gain of MELD points was higher in women (2.6 ± 2.1) than men (2.1 ± 1.9, P < 0.001), and higher in patients with severe ascites (3.3 ± 1.8) than in controls (1.9 ± 1.8, P < 0.001); however, this trend was not significant when the MELD score was higher than 30. When the possible increase in DDLT chance was calculated via up-categorizing using MELD3.0, reducible waitlist mortality was 2.7%.

Conclusion: MELD3.0 could predict better waitlist mortality than MELD; however, the merit for women and patients with severe ascites is uncertain, and reduced waitlist mortality from implementing MELD3.0 is limited in regions suffering from organ shortage, as in Korea.

Keywords: Allocation; Liver Transplantation; MELD; MELD3.0; Waitlist Mortality.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Kaplan–Meier curve analyses for 90-day mortality after first liver transplantation waitlisting. (A) MELD and (B) MELD3.0 groups.
MELD = model for end-stage liver disease.
Fig. 2
Fig. 2. Calibration plot for 90-day mortality. (A) MELD and (B) MELD3.0 groups. Calibration of the predicted and observed risk of 90-day mortality is presented per decile of the population. The diagonal line represents the exact prediction.
MELD = model for end-stage liver disease.
Fig. 3
Fig. 3. Change of MELD points by MELD3.0. Diagonal means same points for original MELD and MELD3.0.
See this image and copyright information in PMC

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