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KMID : 0361120210350010024
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Korean Journal of Transplantation
2021 Volume.35 No. 1 p.24 ~ p.32
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Outcome of patients with severe alcoholic hepatitis after Model for End-Stage Liver Disease-based allocation system implementation in Korea
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Kwon Tae-Jin
Kang Won-Seok
Gwak Geum-Youn
Paik Yong-Han
Choi Moon-Seok
Lee Joon-Hyeok
Koh Kwang-Cheol
Sinn Dong-Hyun
Paik Seung-Woon
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Abstract
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Background: The Model for End-Stage Liver Disease (MELD)-based allocation system was implemented in Korea in July 2016 without a mandatory abstinence period for liver transplantation (LT) listing. However, the impact of the allocation policy has not been evaluated in patients with severe alcoholic hepatitis (AH).
Methods: A total of 81 consecutive patients with severe AH between January 2014 and December 2018 were analyzed. The clinical course of patients before and after the implementation of the MELD-based allocation system was assessed.
Results: More patients received LT (25%?65%) after the MELD allocation system was implemented. The increase in patients receiving deceased donor LT was dramatic (17%?51%, P=0.001) compared to patients receiving living donor LT (7%?14%, P=0.30). The overall survival was better for those who received LT (88% vs. 44% at 1 year, P<0.001), and after the MELD era (1-year survival rate: 80% vs. 50%, P=0.005). Post-LT mortality was observed in six patients, with one case of mortality related to recidivism. Baseline MELD and steroid response were factors associated with transplant-free survival.
Conclusions: After implementation of the MELD-based allocation system, deceased donor LT dramatically increased in patients with severe AH. This translated into increased overall survival, but at a cost of mortality due to recidivism. Urgent evaluation is warranted to identify criteria to justify the use of precious liver grafts from deceased donors for severe AH patients in Korea.
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KEYWORD
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Alcoholic hepatitis, Liver transplantation, Model for End-Stage Liver Disease
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