title: Impact of MELD score implementation on liver allocation: experience at a Brazilian center.
abstract: Introduction. Model for end-stage liver disease (MELD) is an accurate predictor of mortality in patients with cirrhosis, and has been used on liver allocation in Brazil since 2006. However, its impact on organ allocation, waiting list and post-transplant mortality is still poorly characterized. This study aimed to assess the impact of implementation of the MELD system on liver allocation and mortality after liver transplantation (LT) in Southern Brazil. Material and methods. Adult patients with chronic liver disease on the waiting list for primary deceased-donor LT were divided into two cohorts (pre- and post-MELD implementation) according to the date of waiting list placement. Disease severity, as assessed by MELD score at placement, was similar in both cohorts. Patients were followed for at least 18 months to assess the outcomes of interest (death/LT). Results. Higher MELD scores correlated with waiting list mortality, which increased 20% with each additional point (HR 1.2; 95%CI 1.14-2.26; p < 0.001). Waiting list mortality was 30.9% before and 21.7% after MELD implementation (nonsignificant). Transplant rate increased after MELD implementation (52 vs. 40%, p = 0.002). After excluding patients with hepatocellular carcinoma, mean MELD scores at LT were significantly higher in the MELD era (p < 0.01). There was no significant correlation between MELD scores at LT and post-LT survival. During 18-month follow-up, post-LT mortality rate was 25.4% before and 20% after MELD implementation (nonsignificant). Conclusion. MELD implementation was associated with a reduction in waiting list mortality. Although sicker patients received LT in the MELD era, post-transplant survival was similar in both periods.
authors.affiliation: Post Graduate Program in Medicine-Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil.
authors.forename: Adriana Gonçalves
authors.initials: AG
authors.lastname: da Silva Machado
authors.forename: Alfeu
authors.initials: A
authors.lastname: de Medeiros Fleck
authors.forename: Cláudio
authors.initials: C
authors.lastname: Marroni
authors.forename: Maria Lúcia
authors.initials: ML
authors.lastname: Zanotelli
authors.forename: Guido
authors.initials: G
authors.lastname: Cantisani
authors.forename: Ajácio Bandeira
authors.initials: AB
authors.lastname: de Mello Brandão
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D016009:Chi-Square Distribution; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D009927:Tissue and Organ Procurement; D014850:Waiting Lists / Q000401:mortality; D055815:Young Adult