Current status of waitlist mortality and transplant probability for adult candidates with chronic end-stage liver disease for deceased donor liver transplantation under the Model for End-Stage Liver Disease score-based allocation policy in Japan.

IF 5.5 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Yusuke Takemura, Yoshihide Ueda, Ryo Takemura, Junya Mita, Juntaro Ashikari, Kaori Kuramitsu, Yasushi Hasegawa, Minoru Kitago, Hideaki Obara, Yuko Kitagawa, Hideki Ohdan, Hiroyuki Yokota
{"title":"Current status of waitlist mortality and transplant probability for adult candidates with chronic end-stage liver disease for deceased donor liver transplantation under the Model for End-Stage Liver Disease score-based allocation policy in Japan.","authors":"Yusuke Takemura, Yoshihide Ueda, Ryo Takemura, Junya Mita, Juntaro Ashikari, Kaori Kuramitsu, Yasushi Hasegawa, Minoru Kitago, Hideaki Obara, Yuko Kitagawa, Hideki Ohdan, Hiroyuki Yokota","doi":"10.1007/s00535-025-02288-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In Japan's deceased-donor liver transplantation (DDLT), a new allocation policy based on the Model for End-Stage Liver Disease (MELD) score, including the exceptional MELD system (Ex-MELD), which periodically assigns additional points to the basal MELD score, was implemented in May 2019. We assessed the current state of this system for adult candidates with chronic end-stage liver disease.</p><p><strong>Methods: </strong>Adult candidates (≥ 18 years) registered in the Japan Organ Transplant Network for DDLT as Status 2 cases (including chronic end-stage liver disease patients) between May 2019 and April 2023 were evaluated. We divided them into the MELD, Ex-MELD (major) [start 16 points, 2 points by 180 days], and Ex-MELD [hepatocellular carcinoma (HCC)] groups. Transplant probability and waitlist mortality rates were compared using competing risk analyses. The annual proportion of DDLT and the transition of median MELD at transplantation were also investigated.</p><p><strong>Results: </strong>There were 757 candidates in MELD,126 in Ex-MELD (major), and 99 in Ex-MELD (HCC) groups. The transplant probability rates were not significantly different (3-year transplant probability rate; MELD: 24.0% vs. Ex-MELD (major): 21.0% vs. Ex-MELD (HCC): 24.1%). The rate in the Ex-MELD (major) increased dramatically as the waiting period lengthened. The waitlist mortality rates in the Ex-MELD (major) group were significantly lower (3-year waitlist mortality rate; MELD: 50.5% vs. Ex-MELD (major): 25.0% vs. Ex-MELD (HCC): 57.0%). Although the proportion of Ex-MELD (major) increased yearly in the transplanted cases, the median MELD at transplantation did not change significantly.</p><p><strong>Conclusions: </strong>We clearly showed the current status of adult Status 2 candidates.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":5.5000,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00535-025-02288-y","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: In Japan's deceased-donor liver transplantation (DDLT), a new allocation policy based on the Model for End-Stage Liver Disease (MELD) score, including the exceptional MELD system (Ex-MELD), which periodically assigns additional points to the basal MELD score, was implemented in May 2019. We assessed the current state of this system for adult candidates with chronic end-stage liver disease.

Methods: Adult candidates (≥ 18 years) registered in the Japan Organ Transplant Network for DDLT as Status 2 cases (including chronic end-stage liver disease patients) between May 2019 and April 2023 were evaluated. We divided them into the MELD, Ex-MELD (major) [start 16 points, 2 points by 180 days], and Ex-MELD [hepatocellular carcinoma (HCC)] groups. Transplant probability and waitlist mortality rates were compared using competing risk analyses. The annual proportion of DDLT and the transition of median MELD at transplantation were also investigated.

Results: There were 757 candidates in MELD,126 in Ex-MELD (major), and 99 in Ex-MELD (HCC) groups. The transplant probability rates were not significantly different (3-year transplant probability rate; MELD: 24.0% vs. Ex-MELD (major): 21.0% vs. Ex-MELD (HCC): 24.1%). The rate in the Ex-MELD (major) increased dramatically as the waiting period lengthened. The waitlist mortality rates in the Ex-MELD (major) group were significantly lower (3-year waitlist mortality rate; MELD: 50.5% vs. Ex-MELD (major): 25.0% vs. Ex-MELD (HCC): 57.0%). Although the proportion of Ex-MELD (major) increased yearly in the transplanted cases, the median MELD at transplantation did not change significantly.

Conclusions: We clearly showed the current status of adult Status 2 candidates.

在日本终末期肝病评分分配政策下,慢性终末期肝病成年患者等待死亡供肝移植的死亡率和移植概率的现状
背景:在日本的已故供体肝移植(DDLT)中,2019年5月实施了一项基于终末期肝病(MELD)评分模型的新分配政策,包括例外MELD系统(Ex-MELD),该系统定期为基础MELD评分分配额外分数。我们评估了该系统在慢性终末期肝病成人候选人中的现状。方法:评估2019年5月至2023年4月期间在日本器官移植网络登记的DDLT成年候选人(≥18岁)为状态2例(包括慢性终末期肝病患者)。我们将他们分为MELD组、Ex-MELD组(主要)[开始16个点,180天2个点]和Ex-MELD组(肝细胞癌)。使用竞争风险分析比较移植概率和等候名单死亡率。我们还研究了移植时DDLT的年比例和中位MELD的转变。结果:MELD组757例,Ex-MELD(重度)组126例,Ex-MELD (HCC)组99例。两组的移植概率差异无统计学意义(3年移植概率;MELD: 24.0% vs. Ex-MELD(专业):21.0% vs. Ex-MELD (HCC): 24.1%。前meld(主要)的比率随着等待期的延长而急剧增加。前meld(主要)组的等待名单死亡率明显较低(3年等待名单死亡率;MELD: 50.5% vs. Ex-MELD(专业):25.0% vs. Ex-MELD (HCC): 57.0%。虽然移植病例中Ex-MELD (major)的比例逐年增加,但移植时的中位MELD没有明显变化。结论:我们清楚地显示了成人状态2候选人的现状。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of Gastroenterology
Journal of Gastroenterology 医学-胃肠肝病学
CiteScore
12.20
自引率
1.60%
发文量
99
审稿时长
4-8 weeks
期刊介绍: The Journal of Gastroenterology, which is the official publication of the Japanese Society of Gastroenterology, publishes Original Articles (Alimentary Tract/Liver, Pancreas, and Biliary Tract), Review Articles, Letters to the Editors and other articles on all aspects of the field of gastroenterology. Significant contributions relating to basic research, theory, and practice are welcomed. These publications are designed to disseminate knowledge in this field to a worldwide audience, and accordingly, its editorial board has an international membership.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信