title: Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil.
abstract: OBJECTIVE
  To analyze the impact of model for end-stage liver disease (MELD) allocation policy on survival outcomes after liver transplantation (LT).
  
  
  BACKGROUND
  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% vs. 8.14%; 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).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Surgery and Liver Transplantation, Oswaldo Cruz University Hospital, University of Pernambuco, Recife, PE, Brazil. t.paulo@bol.com.br
authors: Thales Paulo
authors: TP
authors: Batista
authors: Bernardo David
authors: BD
authors: Sabat
authors: Paulo Sérgio V
authors: PS
authors: Melo
authors: Luiz Eduardo C
authors: LE
authors: Miranda
authors: Olival Cirilo L
authors: OC
authors: Fonseca-Neto
authors: Américo Gusmão
authors: AG
authors: Amorim
authors: Cláudio Moura
authors: CM
authors: Lacerda
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome