title: The MELD system and liver transplant waiting-list mortality in developing countries: lessons learned from São Paulo, Brazil.
abstract: OBJECTIVE
  The MELD system has not yet been tested as an allocation tool for liver transplantation in the developing countries. In 2006, MELD (Model for End-stage Liver Disease) was launched as a new liver allocation system in São Paulo, Brazil. This study was designed to assess the results of the new allocation policy on waiting list mortality.
  
  
  METHODS
  The State of São Paulo liver transplant database was retrospectively reviewed from July 2003 through July 2009. Patients were divided into those who were transplanted before (Pre-MELD Group) and those who were transplanted after (post-MELD Group) the implementation of the MELD system. Only adult liver transplant candidates were included. Waiting list mortality was the primary endpoint.
  
  
  RESULTS
  The unadjusted death rate in waiting list decreased significantly after the implementation of the MELD system (from 91.2 to 33.5/1,000 patients per year; p<0.0001). Multivariate analysis showed a significant drop in risk of waiting list death for post-MELD patients (HR 0.34; p<0.0001). Currently, 48% of patients are transplanted within 1-year of listing (versus 23% in the pre-MELD era; p<0.0001). Patient and graft survival did not change with MELD implementation.
  
  
  CONCLUSIONS
  There was a reduction in waiting time and list mortality after implementation of the MELD system in São Paulo. Patients listed in the post-MELD era had a significant reduction in risk for the waiting list mortality. There were no changes in post-transplant outcomes. MELD can be successfully utilized for liver transplant allocation in developing countries.
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
authors: Paolo
authors: P
authors: Salvalaggio
authors: Rogerio Carballo
authors: RC
authors: Afonso
authors: Luiz Augusto
authors: LA
authors: Pereira
authors: Ben-Hur
authors: BH
authors: Ferraz-Neto
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D058625:End Stage Liver Disease / Q000401:mortality* / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D015996:Survival Rate; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult