title: Testing liver allocation in São Paulo, Brazil: the relationship of model for end-stage liver disease implementation with a reduction in waiting-list mortality.
abstract: BACKGROUND
  In 2006, the model for end-stage liver disease (MELD) was launched as a new liver allocation system in Sao Paulo, Brazil. We designed this study to assess the results of the new allocation policy on waiting list mortality.
  
  
  METHODS
  We reviewed the state of Sao Paulo liver transplant database from July 2003 through July 2009. Patients were divided in those who were transplanted before (pre-MELD group) and those who were transplanted after (post-MELD group) the implementation of the MELD system. Included were adult liver transplant candidates. Waiting list mortality was the primary endpoint.
  
  
  RESULTS
  The unadjusted death rate in patients on the waiting list decreased significantly after the implementation of the MELD system (from 91.2 to 33.5/1000 patients/year, P < .0001). Multivariate analysis has shown a significant drop of the risk of waiting list death for post-MELD patients (odds ration 0.34, P < .0001).
  
  
  CONCLUSIONS
  There was a reduction in waiting time and list mortality after the implementation of the MELD system in Brazil. Patients listed in the post-MELD era had a significant reduction of death risk on the waiting list. Future studies should assess posttransplant outcomes.
authors.affiliation: Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. salvalaggio@einstein.br
authors.forename: P R
authors.initials: PR
authors.lastname: Salvalaggio
authors.forename: R C
authors.initials: RC
authors.lastname: Afonso
authors.forename: L A
authors.initials: LA
authors.lastname: Pereira
authors.forename: B H
authors.initials: BH
authors.lastname: Ferraz-Neto
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D016009:Chi-Square Distribution; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D009927:Tissue and Organ Procurement; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult