title: Impact of the MELD allocation after its implementation in liver transplantation.
abstract: OBJECTIVE
  On 16 December 2006, most Eurotransplant countries changed waiting time oriented liver allocation policy to the urgency oriented Model for End-stage Liver Disease (MELD) system. There are limited data on the effects of this policy change within the Eurotransplant community.
  
  
  METHODS
  A total of 154 patients who had undergone deceased donor liver transplantation (LT) were retrospectively analyzed in three time periods: period A (1-year pre-MELD, n = 42) versus period B (1-year post-MELD, n = 52) versus period C (2 years after MELD implementation, n = 60).
  
  
  RESULTS
  The median MELD score at the time of LT increased from 16.3 points in period A to 22.4 and 20.4 in periods B and C, respectively (p = 0.007). Waitlist mortality decreased from 18.4% in period A to 10.4% and 9.4% in periods B and C, respectively (p = 0.015). Three-month mortality did not change significantly (10% each for periods A, B and C). One-year survival was 84% for the MELD 6-19 group compared with 81% in the MELD 20-29 group and 74% in the MELD ≥30 group (p = 0.823). Analyzing MELD score and previously described prognostic scores [i.e. survival after liver transplantation (SALT) score and donor-MELD (D-MELD) score] with regard to 1-year survival, only a high risk SALT score was predictive (p = 0.038). In our center, 2 years after implementation of the MELD system, waitlist mortality decreased, while 90-day mortality did not change significantly.
  
  
  CONCLUSIONS
  Up to now, only the SALT score proved to be of prognostic relevance post-transplant.
authors: Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Universitätsklinikum Leipzig, Leipzig, Germany. christoph.benckert@medizin.uni-leipzig.de
authors: Christoph
authors: C
authors: Benckert
authors: Markus
authors: M
authors: Quante
authors: Armin
authors: A
authors: Thelen
authors: Michael
authors: M
authors: Bartels
authors: Sven
authors: S
authors: Laudi
authors: Thomas
authors: T
authors: Berg
authors: Udo
authors: U
authors: Kaisers
authors: Sven
authors: S
authors: Jonas
mesh_terms: D000328:Adult; D058625:End Stage Liver Disease / Q000401:mortality*; D005060:Europe; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008875:Middle Aged; D018579:Patient Selection; D057766:Policy; D011379:Prognosis; D040841:Resource Allocation / Q000379:methods* / Q000458:organization & administration; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014850:Waiting Lists