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Korean J Transplant 2021; 35(1): 24-32

Published online March 31, 2021

https://doi.org/10.4285/kjt.20.0054

© The Korean Society for Transplantation

Outcome of patients with severe alcoholic hepatitis after Model for End-Stage Liver Disease-based allocation system implementation in Korea

Tae Jin Kwon , Wonseok Kang , Geum-Youn Gwak , Yong-Han Paik , Moon Seok Choi , Joon Hyeok Lee , Kwang Cheol Koh , Dong Hyun Sinn , Seung Woon Paik

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Seung Woon Paik
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
Tel: +82-2-3410-3409
Fax: +82-2-3410-6983
E-mail: sw.paik@samsung.com

Received: December 4, 2020; Revised: January 26, 2021; Accepted: January 27, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Alcoholic hepatitis, Liver transplantation, Model for End-Stage Liver Disease

HIGHLIGHTS
  • Since the Model for End-Stage Liver Disease (MELD)-based allocation system was implemented, the overall survival of patients with severe alcoholic hepatitis has improved.

  • The main driver of improved prognosis has been an increase in deceased donor liver transplantation; however, with the risk of mortality from recidivism.

  • The allocation policy for patients with severe alcoholic hepatitis warrants urgent evaluation in the MELD era in Korea.