title: Impact of Model for End-Stage Liver Disease in the occurrence of infectious events and survival in a cohort of liver transplant recipients.
abstract: The Model for End-Stage Liver Disease (MELD), which predicts mortality on the waiting list before liver transplantation, has changed organ allocation criteria to prioritize severely ill patients. The aim of this study was to investigate the impact of the new criteria on the incidence of Healthcare Associated Infections (HAI) and patient survival after liver transplantation. This retrospective cohort included liver transplant recipients from 2005 to 2007. Infection notification followed the recommended criteria of the National Healthcare Safety Network (NHSN). Statistical analysis was performed using the Statistical Package for the Social Sciences. Of 142 patients, 67 (47.2%) underwent transplantation before June 2006. There were no differences between the 2 periods considering patient gender, diagnosis, age, length of hospitalization, and mean time to first infection occurrence. However, the length of intensive care unit (ICU) hospitalization (P = .006) and central venous catheter (CVC) use (P = .025) were higher in the first period of the study. Comparison of time until first systemic infection before and after changes in allocation criteria showed no significant difference (log-rank = 0.06; P = .81). There was a trend toward greater lethality during the second period of the study (P = .09). There was no difference in time to death between the 2 periods (log-rank = 0.9; P = .76). However, when comparing time to death of all patients with systemic infection versus those without this event, patients without infection showed a higher mortality rate (log-rank = 15.7; P < .001).
authors: Alfa Institute of Gastroenterology-Liver Transplant Unit - Hospital das Clínicas/Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. wanclemente@yahoo.com.br
authors: W T
authors: WT
authors: Clemente
authors: R M C
authors: RM
authors: Romanelli
authors: L C
authors: LC
authors: Faria
authors: S S S
authors: SS
authors: Lima
authors: L A
authors: LA
authors: Jesus
authors: J R G
authors: JR
authors: Cortes
authors: M D
authors: MD
authors: Sanches
authors: O L
authors: OL
authors: Cançado
authors: A S
authors: AS
authors: Lima
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001938:Brazil; D015331:Cohort Studies; D003141:Communicable Diseases / Q000150:complications / Q000628:therapy; D058625:End Stage Liver Disease / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult