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홍근,이광웅,서석원,유태석,김혜영,박민수,최영록,이남준,서경석 대한의학회 2013 Journal of Korean medical science Vol.28 No.8
To adopt the model for end-stage liver disease (MELD) score-based system in Korea, the feasibility should be evaluated by analysis of Korean database. The aim of this study was to investigate the feasibility of the MELD score-based system compared with the current Child-Turcotte-Pugh (CTP) based-system and to suggest adequate cut-off to stratify waiting list mortality among Korean population. We included 788 adult patients listed in waiting list in Seoul National University Hospital from January 2008 to May 2011. The short-term survival until 6 months after registration was evaluated. Two hundred forty six (31.2%) patients underwent live donor liver transplantation and 353 (44.8%) patients were still waiting and 121 (15.4%) patients were dropped out due to death. Significant difference was observed when MELD score 24 and 31 were used as cut-off. Three-months survival of Status 2A was 70.2%. However, in Status 2A patients whose MELD score less than 24 (n = 82), 86.6% of patients survived until 6 month. Furthermore, patients with high MELD score ( ≥ 31) among Status 2B group showed poorer survival rate (45.8%,3-month) than Status 2A group. In conclusion, MELD score-based system can predict short term mortality better and select more number of high risk patients in Korean population.
홍근,이남준,유태석,김혜영,박민수,최영록,이경분,이광웅,박명희,서경석 대한의학회 2014 Journal of Korean medical science Vol.29 No.5
Several studies have suggested that a positive lymphocyte cross-matching (XM) isassociated with low graft survival rates and a high prevalence of acute rejection after adultliving donor liver transplantations (ALDLTs) using a small-for-size graft. However, there isstill no consensus on preoperative desensitization. We adopted the desensitization protocolfrom ABO-incompatible LDLT. We performed desensitization for the selected patientsaccording to the degree of T lymphocyte cross-match titer, model for end-stage liverdisease (MELD) score, and graft liver volume. We retrospectively evaluated 230 consecutiveALDLT recipients for 5 yr. Eleven recipients (4.8%) showed a positive XM. Among them,five patients with the high titer ( > 1:16) by antihuman globulin-augmented method(T-AHG) and one with a low titer but a high MELD score of 36 were selected fordesensitization: rituximab injection and plasmapheresis before the transplantation. Therewere no major side effects of desensitization. Four of the patients showed successfuldepletion of the T-AHG titer. There was no mortality and hyperacute rejection inlymphocyte XM-positive patients, showing no significant difference in survival outcomebetween two groups (P = 1.000). In conclusion, this desensitization protocol for theselected recipients considering the degree of T lymphocyte cross-match titer, MELD score,and graft liver volume is feasible and safe.