title: Consequences of the implementation of the Model for End-stage Liver Disease system for liver allocation in Brazil.
abstract: BACKGROUND
  In July 2006, the system for liver allocation in Brazil started to rely on the Model for End-stage Liver Disease (MELD) scale, replacing the previous chronological criteria. Under the new system, the score for listing pediatric patients is obtained by multiplication of the calculated PELD score by 3. The current criteria also features extra points for diseases such as hepatocellular carcinoma (HCC). This study sought to analyze the consequences of implementation of the MELD system on waiting list mortality, posttransplant survival rates and characteristics of the transplanted patients.
  
  
  METHODS
  We retrospectively studied data from the State Health Secretariat of São Paulo, regarding all patients registered on the waiting list for liver transplantation in the State of São Paulo, in two periods: July 2005 to July 2006 (pre-MELD era) and July 2006 to July 2010 (MELD era). Patient survival rates calculated using the Kaplan-Meier method were compared by the log-rank test. P values <.05 were considered statistically relevant.
  
  
  RESULTS
  After implementation of the MELD, waiting list registrations decreased by 39.8%; the percentage of transplants in HCC recipients increased from 2.4% to 23.7%; pediatric transplants increased from 6.5% to 9.3%; deaths on the list fell from 599 in the pre-MELD era to 359 in the last year analyzed; recipients with higher MELD displayed significantly lower posttransplant survival rates; HCC patients, better survival after transplantation (P = .002); No difference was observed comparing survival rates between pre-MELD and MELD eras (P = 474) or between adults and children (P = .867).
  
  
  CONCLUSIONS
  Under the MELD system for liver allocation in Brazil, there was a reduction in waiting list mortality and an increased number of transplantations in pediatric and HCC recipients. Survival rates of patients with higher MELD score were inferior. However, this result was offset by the greater survival in HCC recipients, with no difference in patient survival rates between the pre-MELD and MELD eras.
authors.affiliation: Service of Liver Transplantation, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
authors.forename: R C
authors.initials: RC
authors.lastname: Pestana
authors.forename: E I
authors.initials: EI
authors.lastname: Baracat
authors.forename: P C B
authors.initials: PC
authors.lastname: Massarollo
authors.forename: L A
authors.initials: LA
authors.lastname: Pereira
authors.forename: L A
authors.initials: LA
authors.lastname: Szutan
mesh_terms: D000367:Age Factors; D001938:Brazil; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery; D003661:Decision Support Techniques; D006801:Humans; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D011237:Predictive Value of Tests; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality