title: Improved waiting-list outcomes in Argentina after the adoption of a model for end-stage liver disease-based liver allocation policy.
abstract: In July 2005, Argentina became the first country after the United States to introduce the Model for End-Stage Liver Disease (MELD) for organ allocation. In this study, we investigated waiting-list (WL) outcomes (n = 3272) and post-liver transplantation (LT) survival in 2 consecutive periods of 5 years before and after the implementation of a MELD-based allocation policy. Data were obtained from the database of the national institute for organ allocation in Argentina. After the adoption of the MELD system, there were significant reductions in WL mortality [28.5% versus 21.9%, P < 0.001, hazard ratio (HR) = 1.57, 95% confidence interval (CI) = 1.37-1.81] and total dropout rates (38.6% versus 29.1%, P < 0.001, HR = 1.31, 95% CI = 1.16-1.48) despite significantly less LT accessibility (57.4% versus 50.7%, P < 0.001, HR = 1.53, 95% CI = 1.39-1.68). The annual number of deaths per 1000 patient-years at risk decreased from 273 in 2005 to 173 in 2010, and the number of LT procedures per 1000 patient-years at risk decreased from 564 to 422. MELD and Model for End-Stage Liver Disease-Sodium scores were excellent predictors of 3-month WL mortality with c statistics of 0.828 and 0.857, respectively (P < 0.001). No difference was observed in 1-year posttransplant survival between the 2 periods (81.1% versus 81.3%). Although patients with a MELD score > 30 had lower posttransplant survival, the global accuracy of the score for predicting outcomes was poor, as indicated by a c statistic of only 0.523. Patients with granted MELD exceptions (158 for hepatocellular carcinoma and 52 for other reasons) had significantly higher access to LT (80.4%) in comparison with nonexception patients with equivalent listing priority (MELD score = 18-25; 54.6%, P < 0.001, HR = 0.49, 95% CI = 0.40-0.61). In conclusion, the adoption of the MELD model in Argentina has resulted in improved liver organ allocation without compromising posttransplant survival.
authors.affiliation: Transplant Society of Argentina, Buenos Aires, Argentina. noracejas@msn.com
authors.forename: Nora Gabriela
authors.initials: NG
authors.lastname: Cejas
authors.forename: Federico G
authors.initials: FG
authors.lastname: Villamil
authors.forename: Javier C
authors.initials: JC
authors.lastname: Lendoire
authors.forename: Viviana
authors.initials: V
authors.lastname: Tagliafichi
authors.forename: Arturo
authors.initials: A
authors.lastname: Lopez
authors.forename: Daniela Hansen
authors.initials: DH
authors.lastname: Krogh
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Soratti
authors.forename: Liliana
authors.initials: L
authors.lastname: Bisigniano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001118:Argentina; D058625:End Stage Liver Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D016016:Proportional Hazards Models; D040841:Resource Allocation / Q000379:methods; D012306:Risk; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult