Adoption of MELD score increases the number of liver transplant

Abstract

BackgroundLiver transplantation is performed at large transplant centers worldwide as a therapeutic intervention for patients with end-stage liver diseases.AimTo analyze the outcomes and incidence of liver transplantation performed at the University of São Paulo and to compare those with the State of São Paulo before and after adoption of the Model for End-Stage Liver Disease (MELD) score.MethodEvaluation of the number of liver transplantations before and after adoption of the MELD score. Mean values and standard deviations were used to analyze normally distributed variables. The incidence results were compared with those of the State of São Paulo.ResultsThere was a high prevalence of male patients, with a predominance of middle-aged. The main indication for liver transplantation was hepatitis C cirrhosis. The mean and median survival rates and overall survival over ten and five years were similar between the groups (p>0.05). The MELD score increased over the course of the study period for patients who underwent liver transplantation (p>0.05). There were an increased number of liver transplants after adoption of the MELD score at this institution and in the State of São Paulo (p<0.001).ConclusionThe adoption of the MELD score led to increase the number of liver transplants performed in São Paulo.

The Impact of the Meld Score on Liver Transplant Allocation and Results: An Integrative Review

“…In cases of dual (liver-kidney) transplants, the short-term survival rate was similar but, in the long term, a single (liver) transplant had a better outcome 20 . Hepatocellular carcinoma did not correlate with a worse survival rate and cases that were not in an advanced stage were found to be associated with lower postoperative morbidity and mortality 11 , 17 .…”

Liver Transplantation for Carcinoma Hepatocellular in São Paulo: 414 Cases by the Milan/Brazil Criteria

“…The challenge in adopting an extra score is seeking criteria that reduce the chance of being prioritizing patients with advanced HCC, with high risk of recurrence, instead of patients with higher MELD score 6 , 22 , 24 , 29 .…”

“…Some comparative studies have demonstrated the safety of expanded the Milan criteria, to include more patients without increasing the HCC recurrence rate 4 , 22 . The implantation of MC in Brazil was followed by minor modifications.…”

Use of a severity indicator as a predictor of the use of hepatic transplantation resources

“…According to some scholars (13) , "liver transplantation has been used as a therapy for end-stage liver diseases since the 1980s, after its approval by the National Health Institute of the United States of America (USA) in 1983 and, consequently, there was a mortality increase in the waiting lists of transplantation centers in general". The high mortality rate in the waiting list for the procedure led to the development of strategies to reduce it.…”

“…The high mortality rate in the waiting list for the procedure led to the development of strategies to reduce it. One was the change in the queue handling criteria, which until mid-2003 (USA) and 2006 (Brazil) occurred in chronological order of registration and started using the MELD score (Model for End-Stage Liver Disease), a mathematical model for predicting risk of death established from clinical and laboratory parameters, whose main characteristic is to predict the survival of patients in the first three months after placement of percutaneous intrahepatic portosystemic shunt (TIPS) (13) . With the implementation of the MELD, there was a revision in practices, in order of selection of potential receptors and implementation of planning tools that enable a reasonable degree of predictability in the practice (14) .…”