Use of Liver Grafts From Deceased Organ Donors With Infectious Diseases.

INTRODUCTION: Liver transplant is the only option in reversing liver insufficiency and its complications. It is very important to realize the quality control of organs and tissues used in transplant, as well as to develop diagnostic, treatment, and prophylaxis techniques to prevent other comorbidities and to increase the survival of transplanted patients. OBJECTIVES: The study describes the characteristics of liver transplant using organs with infectious diseases realized by Liver Transplantation Unit (LTU) of the University Hospital Oswaldo Cruz (UHOC). METHODS: The methodology is a descriptive, cross-sectional, and retrospective study, with a quantitative approach of all patients submitted for liver transplantation between 2013 and 2017. The research was realized at LTU ambulatory of the UHOC from the analysis of medical records using a semistructured collect instrument for the information acquisition. RESULTS: Researchers analyzed 127 medical records, 85% of which had transmissible diseases and 15% of which had infectious diseases. Of the infectious diseases, it was observed that 85% were syphilis (16 cases), followed by 10% with Chagas disease and 5% with cytomegalovirus (CMV). The transplant outcomes showed that 68% of organ receptors with infectious diseases achieved good recovery. CONCLUSION: Organ transplant for those with infectious diseases is a treatment option to improve the life quality of people at any age who present with a chronic disease, where its use has been an alternative well accepted due to the shortage of livers for transplants.

THE USE OF MELD SCORE (MODEL FOR END-STAGE LIVER DISEASE) AND DERIVATIVES IN CARDIAC TRANSPLANTATION.

INTRODUCTION: Heart transplantation is still the best therapeutic alternative for the treatment of end-stage heart failure. The use of criteria that consider the complications associated with this procedure can guarantee a better evaluation of the recipient and prepare the team for possible unsatisfactory post-transplant results. The use of the MELD score has been expanded to evaluate cirrhotic patients undergoing various procedures, including cardiac transplantation. OBJECTIVE: To analyze the knowledge on MELD score and its derivatives to the prognosis of patients with end-stage heart failure considered for heart transplantation. METHOD: Was carried out an integrative review of the publications of the last ten years in Pubmed and Lilacs databases, using the descriptors "heart transplantation", "liver disease" and "prognosis". From the total of 111 articles found, six were selected and composed the sample. RESULTS: The MELD-XI score (eXcluding INR) was the most analyzed in the studies due to the exclusion of INR, since many patients with heart failure use anticoagulants, which may alter their value. MELD and derivatives were associated with unsatisfactory results in cardiac transplantation. CONCLUSION: The MELD score can be considered as a good predictor for heart transplantation; however, there are still few studies that make this correlation.

The use of meld score (model for end-stage liver disease) and derivatives in cardiac transplantation / A utilização do escore meld (model for end-stage liver disease) e derivados no transplante cardíaco

ABSTRACT Introduction: Heart transplantation is still the best therapeutic alternative for the treatment of end-stage heart failure. The use of criteria that consider the complications associated with this procedure can guarantee a better evaluation of the recipient and prepare the team for possible unsatisfactory post-transplant results. The use of the MELD score has been expanded to evaluate cirrhotic patients undergoing various procedures, including cardiac transplantation. Objective: To analyze the knowledge on MELD score and its derivatives to the prognosis of patients with end-stage heart failure considered for heart transplantation. Method: Was carried out an integrative review of the publications of the last ten years in Pubmed and Lilacs databases, using the descriptors "heart transplantation", "liver disease" and "prognosis". From the total of 111 articles found, six were selected and composed the sample. Results: The MELD-XI score (eXcluding INR) was the most analyzed in the studies due to the exclusion of INR, since many patients with heart failure use anticoagulants, which may alter their value. MELD and derivatives were associated with unsatisfactory results in cardiac transplantation. Conclusion: The MELD score can be considered as a good predictor for heart transplantation; however, there are still few studies that make this correlation.

RESUMO Introdução : O transplante de coração ainda é a melhor alternativa terapêutica para o tratamento da insuficiência cardíaca terminal. A utilização de critérios que considerem as complicações associadas a esse procedimento pode garantir melhor avaliação do receptor e preparar a equipe para possíveis resultados insatisfatórios no pós-transplante. O uso do escore MELD vem sendo expandido para avaliar pacientes cirróticos submetidos a diversos procedimentos, incluindo o transplante cardíaco. Objetivo : Analisar o conhecimento produzido relacionando o escore MELD e os seus derivados com o prognóstico dos pacientes com insuficiência cardíaca terminal considerados para o transplante cardíaco. Método : Foi realizada revisão integrativa das publicações dos últimos dez anos nas bases de dados Pubmed e Lilacs, utilizando os descritores "transplante cardíaco", "doença hepática" e "prognóstico". Do total de 111 artigos encontrados, seis foram selecionados e compuseram a amostra. Resultados : O escore MELD-XI (eXcluding INR) foi o mais analisado nos estudos devido à exclusão do INR, já que boa parte dos pacientes com insuficiência cardíaca fazem uso de anticoagulantes, podendo alterar o seu valor. O MELD e derivados esteve associado aos resultados insatisfatórios no transplante cardíaco. Conclusão : O escore MELD pode ser considerado como bom preditor para o transplante cardíaco; porém, ainda são poucos os estudos que fazem essa correlação.

THE IMPACT OF THE MELD SCORE ON LIVER TRANSPLANT ALLOCATION AND RESULTS: AN INTEGRATIVE REVIEW.

Introduction: Liver transplantation is intended to increase the survival of patients with chronic liver disease in terminal phase, as well as improved quality of life. Since the first transplant until today many changes have occurred in the organ allocation system. Objective: To review the literature on the Model for End-stage Liver Disease (MELD) and analyze its correlation with survival after liver transplantation. Method: An integrative literature review in Lilacs, SciELO, and Pubmed in October 2015, was realized. Were included eight studies related to the MELD score and its impact on liver transplant. Results: There was predominance of transplants in male between 45-55 y. The main indications were hepatitis C, hepatocellular carcinoma and alcoholic cirrhosis. The most important factors post-surgery were related to the MELD score, the recipient age, expanded donor criteria and hemotransfusion. Conclusion: The MELD system reduced the death rate in patients waiting for a liver transplant. However, this score by itself is not a good predictor of survival after liver transplantation.

Introdução: O transplante de fígado tem como finalidade o aumento da sobrevida dos pacientes com doença hepática crônica em fase terminal, além de melhora na qualidade de vida. Desde o primeiro transplante até os dias atuais, muitas mudanças ocorreram no sistema de alocação de órgãos. Objetivo: Analisar o conhecimento produzido sobre o Model for End-stage Liver Disease (MELD) e a sua relação com a sobrevida no pós-transplante de fígado. Método: Realizou-se revisão integrativa nas bases de dados Lilacs, SciELO e Pubmed no mês de outubro de 2015. A amostra contou com oito estudos relacionando o escore MELD e o seu impacto no transplante de fígado. Resultados: Houve predomínio dos transplantes realizados em homens e faixa etária entre 45-55 anos. Como principais indicações tem-se hepatite C, hepatocarcinoma e cirrose por álcool. Os fatores que tiveram maior impacto no pós-operatório estão associados ao alto valor do MELD, idade do receptor, critérios expandidos do doador e hemotransfusão. Conclusão: O sistema MELD reduziu a mortalidade na fila de espera, mas isoladamente não é um bom preditor de sobrevivência no pós-transplante de fígado.

The impact of the meld score on liver transplant allocation and results: an integrative review / Impacto do escore meld na alocação de fígado e nos resultados dos transplantes hepáticos: uma revisão integrativa

ABSTRACT Introduction: Liver transplantation is intended to increase the survival of patients with chronic liver disease in terminal phase, as well as improved quality of life. Since the first transplant until today many changes have occurred in the organ allocation system. Objective: To review the literature on the Model for End-stage Liver Disease (MELD) and analyze its correlation with survival after liver transplantation. Method: An integrative literature review in Lilacs, SciELO, and Pubmed in October 2015, was realized. Were included eight studies related to the MELD score and its impact on liver transplant. Results: There was predominance of transplants in male between 45-55 y. The main indications were hepatitis C, hepatocellular carcinoma and alcoholic cirrhosis. The most important factors post-surgery were related to the MELD score, the recipient age, expanded donor criteria and hemotransfusion. Conclusion: The MELD system reduced the death rate in patients waiting for a liver transplant. However, this score by itself is not a good predictor of survival after liver transplantation.

RESUMO Introdução: O transplante de fígado tem como finalidade o aumento da sobrevida dos pacientes com doença hepática crônica em fase terminal, além de melhora na qualidade de vida. Desde o primeiro transplante até os dias atuais, muitas mudanças ocorreram no sistema de alocação de órgãos. Objetivo: Analisar o conhecimento produzido sobre o Model for End-stage Liver Disease (MELD) e a sua relação com a sobrevida no pós-transplante de fígado. Método: Realizou-se revisão integrativa nas bases de dados Lilacs, SciELO e Pubmed no mês de outubro de 2015. A amostra contou com oito estudos relacionando o escore MELD e o seu impacto no transplante de fígado. Resultados: Houve predomínio dos transplantes realizados em homens e faixa etária entre 45-55 anos. Como principais indicações tem-se hepatite C, hepatocarcinoma e cirrose por álcool. Os fatores que tiveram maior impacto no pós-operatório estão associados ao alto valor do MELD, idade do receptor, critérios expandidos do doador e hemotransfusão. Conclusão: O sistema MELD reduziu a mortalidade na fila de espera, mas isoladamente não é um bom preditor de sobrevivência no pós-transplante de fígado.