title: The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo, Brazil.
abstract: Until July 15, 2006, the time on the waiting list was the main criterion for allocating deceased donor livers in the state of São Paulo, Brazil. After this date, MELD has been the basis for the allocation of deceased donor livers for adult transplantation. Our aim was to compare the waitlist dynamics before MELD (1997-2005) and after MELD (2006-2012) in our state. A retrospective study was conducted including the data from all the liver transplant candidate waiting lists from July 1997 to December 2012. The data were related to the actual number of liver transplantations (Tr), the incidence of new patients on the list (I), and the number of patients who died while being on the waitlist (D) from 1997 to 2005 (the pre-MELD era) and from 2006 to 2012 (the post-MELD era). The number of transplantations from 1997 to 2005 and from 2006 to 2012 increased nonlinearly, with a clear trend to levelling to equilibrium at approximately 350 and 500 cases per year, respectively. The implementation of the MELD score resulted in a shorter waiting time until liver transplantation. Additionally, there was a significant effect on the waitlist dynamics in the first 4 years; however, the curves diverge from there, implying a null long-range effect on the waitlist by the MELD scores.
authors.affiliation: Division of Liver Transplantation, LIM 37, Department of Gastroenterology, São Paulo School of Medicine, Suite 3206, 3rd Foor, 01246-903 São Paulo, SP, Brazil.
authors.forename: Eleazar
authors.identifier: 0000-0002-9496-610X
authors.initials: E
authors.lastname: Chaib
authors.affiliation: Department of Informatics, LIM 01, University of São Paulo School of Medicine, 01246-903 São Paulo, SP, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Massad
authors.affiliation: Division of Liver Transplantation, LIM 37, Department of Gastroenterology, São Paulo School of Medicine, Suite 3206, 3rd Foor, 01246-903 São Paulo, SP, Brazil.
authors.forename: Bruno Butturi
authors.initials: BB
authors.lastname: Varone
authors.affiliation: Division of Liver Transplantation, LIM 37, Department of Gastroenterology, São Paulo School of Medicine, Suite 3206, 3rd Foor, 01246-903 São Paulo, SP, Brazil.
authors.forename: Andre Leopoldino
authors.initials: AL
authors.lastname: Bordini
authors.affiliation: Division of Liver Transplantation, LIM 37, Department of Gastroenterology, São Paulo School of Medicine, Suite 3206, 3rd Foor, 01246-903 São Paulo, SP, Brazil.
authors.forename: Flavio Henrique Ferreira
authors.initials: FH
authors.lastname: Galvão
authors.affiliation: Division of Liver Transplantation, LIM 37, Department of Gastroenterology, São Paulo School of Medicine, Suite 3206, 3rd Foor, 01246-903 São Paulo, SP, Brazil.
authors.forename: Alessandra
authors.identifier: 0000-0003-2123-9697
authors.initials: A
authors.lastname: Crescenzi
authors.affiliation: Division of Liver Transplantation, LIM 37, Department of Gastroenterology, São Paulo School of Medicine, Suite 3206, 3rd Foor, 01246-903 São Paulo, SP, Brazil.
authors.forename: Arnaldo Bernal
authors.initials: AB
authors.lastname: Filho
authors.affiliation: Division of Liver Transplantation, LIM 37, Department of Gastroenterology, São Paulo School of Medicine, Suite 3206, 3rd Foor, 01246-903 São Paulo, SP, Brazil.
authors.forename: Luiz Augusto Carneiro
authors.initials: LA
authors.lastname: D'Albuquerque