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Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil
Batista, Thales Paulo; Sabat, Bernardo David; Melo, Paulo Sérgio V; Miranda, Luiz Eduardo C; Fonseca-Neto, Olival Cirilo L; Amorim, Américo Gusmão; Lacerda, Cláudio Moura.
  • Batista, Thales Paulo; University of Pernambuco. Oswaldo Cruz University Hospital. Department of Surgery and Liver Transplantation. Recife. BR
  • Sabat, Bernardo David; University of Pernambuco. Oswaldo Cruz University Hospital. Department of Surgery and Liver Transplantation. Recife. BR
  • Melo, Paulo Sérgio V; University of Pernambuco. Oswaldo Cruz University Hospital. Department of Surgery and Liver Transplantation. Recife. BR
  • Miranda, Luiz Eduardo C; University of Pernambuco. Oswaldo Cruz University Hospital. Department of Surgery and Liver Transplantation. Recife. BR
  • Fonseca-Neto, Olival Cirilo L; University of Pernambuco. Oswaldo Cruz University Hospital. Department of Surgery and Liver Transplantation. Recife. BR
  • Amorim, Américo Gusmão; University of Pernambuco. Oswaldo Cruz University Hospital. Department of Surgery and Liver Transplantation. Recife. BR
  • Lacerda, Cláudio Moura; University of Pernambuco. Oswaldo Cruz University Hospital. Department of Surgery and Liver Transplantation. Recife. BR
Clinics ; 66(1): 57-64, 2011. ilus, tab
Article in English | LILACS | ID: lil-578597
ABSTRACT

OBJECTIVE:

To analyze the impact of model for end-stage liver disease (MELD) allocation policy on survival outcomes after liver transplantation (LT).

INTRODUCTION:

Considering that an ideal system of grafts allocation should also ensure improved survival after transplantation, changes in allocation policies need to be evaluated in different contexts as an evolutionary process.

METHODS:

A retrospective cohort study was carried out among patients who underwent LT at the University of Pernambuco. Two groups of patients transplanted before and after the MELD allocation policy implementation were identified and compared using early postoperative mortality and post-LT survival as end-points.

RESULTS:

Overall, early postoperative mortality did not significantly differ between cohorts (16.43 percent vs. 8.14 percent; p = 0.112). Although at 6 and 36-months the difference between pre-vs. post-MELD survival was only marginally significant (p = 0.066 and p = 0.063; respectively), better short, medium and long-term post-LT survival were observed in the post-MELD period. Subgroups analysis showed special benefits to patients categorized as nonhepatocellular carcinoma (non-HCC) and moderate risk, as determined by MELD score (15-20).

DISCUSSION:

This study ensured a more robust estimate of how the MELD policy affected post-LT survival outcomes in Brazil and was the first to show significantly better survival after this new policy was implemented. Additionally, we explored some potential reasons for our divergent survival outcomes.

CONCLUSION:

Better survival outcomes were observed in this study after implementation of the MELD criterion, particularly amongst patients categorized as non-HCC and moderate risk by MELD scoring. Governmental involvement in organ transplantation was possibly the main reason for improved survival.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Liver Transplantation / End Stage Liver Disease Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Adult / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Clinics Journal subject: Medicine Year: 2011 Type: Article Affiliation country: Brazil Institution/Affiliation country: University of Pernambuco/BR

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Full text: Available Index: LILACS (Americas) Main subject: Liver Transplantation / End Stage Liver Disease Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Adult / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Clinics Journal subject: Medicine Year: 2011 Type: Article Affiliation country: Brazil Institution/Affiliation country: University of Pernambuco/BR