Analysis of the survival of cirrhotic patients enlisted for liver transplantation in the pre- and post-MELD era in southern Brazil.
BACKGROUND
Transplantation is the only cure for decompensated cirrhosis. Model for End-Stage Liver Disease (MELD) is used in liver allocation.


OBJECTIVE
Comparing survival of enlisted populations in pre- and post-MELD eras and estimating their long-term survival.


METHODS
This is a retrospective study of cirrhotics enlisted for transplantation during pre- and post-MELD eras. Survival curves were generated using Kaplan-Meier's model. Cox's model was used to determine risk factors for mortality. Exponential, Weibull's, normal-log and Gompertz's models were used to estimate long-term survival.


RESULTS
The study included 162 patients enlisted in pre-MELD era and 184 in post-MELD period. Kaplan-Meier's survival curve of patients enlisted in post-MELD era was better than that of pre-MELD period (P = 0.009). This difference remained for long-term estimates, with a survival of 53.54% in 5 years and 44.64% in 10 years for patients enlisted in post-MELD era and of 43.17% and 41.75% for pre-MELD period. Era in which patients had been enlisted (P = 0.010) and MELD score at enlistment (P<0.001) were independently associated to survival with hazard ratios of 0.664 (95% CI-confidence interval = 0.487-0.906) and 1.069 (95% CI = 1.043-1.095).


CONCLUSIONS
MELD-based transplantation policy is superior to chronology-based one, promoting better survival for enlisted patients, even in long-term.
Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.
Ângelo Zambam de
ÂZ
Mattos
Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.
Angelo Alves de
AA
Mattos
Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.
Fernanda Karlinski Fernandes
FK
Sacco
Hospital São Vicente de Paulo, Passo Fundo, RS, Brasil.
Lísia
L
Hoppe
Central de Transplantes do Estado do Rio Grande do Sul, Porto Alegre, RS, Brasil.
Denise Maria Sarti de
DM
Oliveira
D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists