SciELO - Scientific Electronic Library Online

 
vol.10 issue3Comparative analysis of gestations and frequency of prematurity and low birth weight among children of adolescent and adult mothersThe detection of KIT mutations in acute myeloid leukemia author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Einstein (São Paulo)

Print version ISSN 1679-4508

Abstract

SALVALAGGIO, Paolo; AFONSO, Rogerio Carballo; PEREIRA, Luiz Augusto  and  FERRAZ-NETO, Ben-Hur. The MELD system and liver transplant waiting-list mortality in developing countries: lessons learned from São Paulo, Brazil. Einstein (São Paulo) [online]. 2012, vol.10, n.3, pp. 278-285. ISSN 1679-4508.  http://dx.doi.org/10.1590/S1679-45082012000300004.

OBJECTIVE: The MELD system has not yet been tested as an allocation tool for liver transplantation in the developing countries. In 2006, MELD (Model for End-stage Liver Disease) was launched as a new liver allocation system in São Paulo, Brazil. This study was designed to assess the results of the new allocation policy on waiting list mortality. METHODS: The State of São Paulo liver transplant database was retrospectively reviewed from July 2003 through July 2009. Patients were divided into those who were transplanted before (Pre-MELD Group) and those who were transplanted after (post-MELD Group) the implementation of the MELD system. Only adult liver transplant candidates were included. Waiting list mortality was the primary endpoint. RESULTS: The unadjusted death rate in waiting list decreased significantly after the implementation of the MELD system (from 91.2 to 33.5/1,000 patients per year; p<0.0001). Multivariate analysis showed a significant drop in risk of waiting list death for post-MELD patients (HR 0.34; p<0.0001). Currently, 48% of patients are transplanted within 1-year of listing (versus 23% in the pre-MELD era; p<0.0001). Patient and graft survival did not change with MELD implementation. CONCLUSION: There was a reduction in waiting time and list mortality after implementation of the MELD system in São Paulo. Patients listed in the post-MELD era had a significant reduction in risk for the waiting list mortality. There were no changes in post-transplant outcomes. MELD can be successfully utilized for liver transplant allocation in developing countries.

Keywords : Liver transplantation; Severity of illness index; Liver transplantation; Waiting lists [mortality]; Developing countries; Brazil.

        · abstract in Portuguese     · text in English | Portuguese     · pdf in English | Portuguese