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Meld score 15 prognosis10/30/2023 This study was a single-center, retrospective cohort study conducted at the Samsung Medical Center, Seoul, South Korea. ![]() ![]() Since this study used only de-identified data routinely collected during hospital visits, the requirement to obtain informed patient consent was waived. The study protocol was approved by the Ethics Committee of the Samsung Medical Center (IRB No. Therefore, in this study, we compared the clinical outcomes of patients with severe AH before and after the MELD-based allocation system to determine the impact of the change in allocation system on the outcomes of patients with severe AH in Korea. However, the impact of the allocation system change on the outcomes of patients with severe AH has not been assessed. The change in the liver allocation system has had a huge impact on potential LT candidates, including patients with severe AH. In Korea, the liver allocation system for deceased donor LT (DDLT) has been based on the Child-Turcotte-Pugh score however, to increase objectivity and equality of allocation, a Model for End-Stage Liver Disease (MELD)-based allocation system was implemented in June 2016. However, LT for AH as a rescue therapy is also controversial, especially in terms of the selection criteria justifying the use of precious liver grafts. Early liver transplantation (LT) for severe AH is a potentially life-saving treatment with established survival benefits. Patients with severe AH unresponsive to medical therapy have 1-year mortality rates of up to 70%–90%. Corticosteroids administered to patients with severe AH increase the risk of developing serious infections and may increase the risk of mortality in patients who experience infection. However, the benefits of corticosteroid treatment remain controversial. Corticosteroids are the only treatment option shown to reduce mortality from severe AH. The cornerstone therapy for AH is nutrition and abstinence from alcohol however, this is not often successful. To date, the management of severe AH remains a clinical challenge with few effective treatment options. Severe AH is defined as an MDF score ≥32 and is associated with a survival rate of 50%–65%, while patients with an MDF score <32 is associated with a survival rate of 90%. The modified discriminant function (MDF) score has been widely used to stratify AH severity. AH is a clinical syndrome that affects patients with chronic and active harmful alcohol consumption and is associated with high mortality. Keywords: Alcoholic hepatitis, Liver transplantation, Model for End-Stage Liver DiseaseĪlcoholic liver disease represents a spectrum of injuries, ranging from simple steatosis and alcoholic hepatitis (AH) to cirrhosis. Urgent evaluation is warranted to identify criteria to justify the use of precious liver grafts from deceased donors for severe AH patients in Korea. This translated into increased overall survival, but at a cost of mortality due to recidivism. Baseline MELD and steroid response were factors associated with transplant-free survival.Ĭonclusions: After implementation of the MELD-based allocation system, deceased donor LT dramatically increased in patients with severe AH. Post-LT mortality was observed in six patients, with one case of mortality related to recidivism. 44% at 1 year, P<0.001), and after the MELD era (1-year survival rate: 80% vs. The overall survival was better for those who received LT (88% vs. 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). Results: More patients received LT (25%–65%) after the MELD allocation system was implemented. ![]() The clinical course of patients before and after the implementation of the MELD-based allocation system was assessed. Methods: A total of 81 consecutive patients with severe AH between January 2014 and December 2018 were analyzed. However, the impact of the allocation policy has not been evaluated in patients with severe alcoholic hepatitis (AH). 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.
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