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논문 기본 정보

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저자정보
Tae Jin Kwon (Department of Medicine Samsung Medical Center Sungkyunkwan University School of Medicine) Wonseok Kang (Department of Medicine Samsung Medical Center Sungkyunkwan University School of Medicine) Geum-Youn Gwak (Department of Medicine Samsung Medical Center Sungkyunkwan University School of Medicine) Yong-Han Paik (Department of Medicine Samsung Medical Center Sungkyunkwan University School of Medicine) Moon Seok Choi (Department of Medicine Samsung Medical Center Sungkyunkwan University School of Medicine) Joon Hyeok Lee (Department of Medicine Samsung Medical Center Sungkyunkwan University School of Medicine) Kwang Cheol Koh (Department of Medicine Samsung Medical Center Sungkyunkwan University School of Medicine) Dong Hyun Sinn (Department of Medicine Samsung Medical Center Sungkyunkwan University School of Medicine) Seung Woon Paik (Department of Medicine Samsung Medical Center Sungkyunkwan University School of Medicine)
저널정보
대한이식학회 Clinical Transplantation and Research Korean Journal of Transplantation Vol.35 No.1
발행연도
2021.1
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24 - 32 (9page)

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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.
#Alcoholic hepatitis #Liver transplantation #Model for End-Stage Liver Disease

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참고문헌 (29)

참고문헌 신청
Korean Association for the Study of the Liver(KASL) / 2013 / KASL clinical practice guidelines : management of alcoholic liver disease / Clin Mol Hepatol 19:216~254 google schola Lucey MR / 2009 / Alcoholic hepatitis / N Engl J Med 360:2758~2769 google schola Shipley LC / 2019 / Recent updates on alcoholic hepatitis / Dig Liver Dis 51:761~768 google schola Mathurin P / 2011 / Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis : meta-analysis of individual patient data / Gut 60:255~260 google schola Liu M / 2019 / New prospects for medical management of acute alcoholic hepatitis / Clin Liver Dis(Hoboken) 13:131~135 google schola

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