A seleção de pacientes utilizando-se o critério meld melhora a sobrevida a curto prazo dos pacientes submetidos ao transplante de fígado?

Chaib, Eleazar; Figueira, Estela Regina Ramos; Brunheroto, André; Gatti, Arthur Paredes; Fernandes, Daniela Silvestrini; D'Albuquerque, Luiz Augusto Carneiro

doi:10.1590/s0102-67202013000400014

Cited by 10 publications

(8 citation statements)

References 7 publications

(8 reference statements)

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“…In particular, a MELD cut-off value of 20 was chosen to verify the possible correlation between thromboelastographic reference range and MELD score. This cut-off is the most frequently used parameter in the literature for predicting mortality risk after LT[ 12 , 13 ]. Two TEG ® 5000 Hemostasis Analyzers (Haemoscope Inc., Skokie, Illinois, United States) were used.…”

Section: Methodsmentioning

confidence: 99%

Thromboelastographic reference ranges for a cirrhotic patient population undergoing liver transplantation

Pietri¹,

Bianchini²,

Rompianesi³

et al. 2016

WJT

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AIMTo describe the thromboelastography (TEG) “reference” values within a population of liver transplant (LT) candidates that underline the differences from healthy patients.METHODSBetween 2000 and 2013, 261 liver transplant patients with a model for end-stage liver disease (MELD) score between 15 and 40 were studied. In particular the adult patients (aged 18-70 years) underwent to a first LT with a MELD score between 15 and 40 were included, while all patients with acute liver failure, congenital bleeding disorders, and anticoagulant and/or antiplatelet drug use were excluded. In this population of cirrhotic patients, preoperative haematological and coagulation laboratory tests were collected, and the pretransplant thromboelastographic parameters were studied and compared with the parameters measured in a previously studied population of 40 healthy subjects. The basal TEG parameters analysed in the cirrhotic population of liver candidates were as follows: Reaction time (r), coagulation time (k), Angle-Rate of polymerization of clot (α Angle), Maximum strenght of clot (MA), Amplitudes of the TEG tracing at 30 min and 60 min after MA is measured (A30 and A60), and Fibrinolysis at 30 and 60 min after MA (Ly30 and Ly60). The possible correlation between the distribution of the reference range and the gender, age, MELD score (higher or lower than 20) and indications for transplantation (liver pathology) were also investigated. In particular, a MELD cut-off value of 20 was chosen to verify the possible correlation between the thromboelastographic reference range and MELD score.RESULTSMost of the TEG reference values from patients with end-stage liver disease were significantly different from those measured in the healthy population and were outside the suggested normal ranges in up to 79.3% of subjects. Wide differences were found among all TEG variables, including r (41.5% of the values), k (48.6%), α (43.7%), MA (79.3%), A30 (74.4%) and A60 (80.9%), indicating a prevailing trend to hypocoagulability. The differences between the mean TEG values obtained from healthy subjects and the cirrhotic population were statistically significant for r (P = 0.039), k (P < 0.001), MA (P < 0.001), A30 (P < 0.001), A60 (P < 0.001) and Ly60 (P = 0.038), indicating slower and less stable clot formation in the cirrhotic patients. In the cirrhotic population, 9.5% of patients had an r value shorter than normal, indicating a tendency for faster clot formation. Within the cirrhotic patient population, gender, age and the presence of hepatocellular carcinoma or alcoholic cirrhosis were not significantly associated with greater clot firmness or enhanced whole blood clot formation, whereas greater clot strength was associated with a MELD score < 20, hepatitis C virus and cholestatic-related cirrhosis (P < 0.001; P = 0.013; P < 0.001).CONCLUSIONThe range and distribution of TEG values in cirrhotic patients differ from those of healthy subjects, suggesting that a specific thromboelastographic reference range is required for liver transplant can...

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“…Currently, the MELD is the resource used to prioritize patients on the waiting list for liver transplantation. Research review conducted in three databases on this model of organ allocation with 30 items showed that the MELD score has significantly increased the short-term survival rate of the most serious patients of the waiting list for liver transplant, but had no significant impact on the survival rate of less serious patients (14) .…”

Section: Discussionmentioning

confidence: 99%

Quality of life after liver transplantation with old donor graft

Flor¹,

Garcia²,

Aguiar³

et al. 2016

Rev Rene

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Objective: to compare the quality of life of liver transplant patients who received liver from donor aged ≤60 or >60 years old. Methods: a prospective study with a sample of 141 recipients from liver donors aged equal to or less than 60 years and recipients of elderly donor liver, in a reference center. Authors used a tool for identification and the Short Form-36. The Student-t and Mann-Whitney tests were applied for comparison between groups. Results: there were higher levels of quality of life with a statistically significant difference: Group A in social aspect (p=0.02) and Group B >50 months of transplantation (p=0.05) in physical component summary. Conclusion: the quality of life of liver receptors from older donor livers was similar to those who received a graft from younger donors in most dimensions. Transplanting time had a positive impact on the quality of life of elderly recipients.

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“…In Machado 15 , various studies attempted to relate this score to the post-transplant period and establish a cut-off point to guide the decision not to perform transplantation, despite the worst outcomes occurring with the higher MELD scores. But this was not possible 7 .…”

Section: Discussionmentioning

confidence: 99%

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

Moraes

Oliveira²,

Fonseca-Neto³

2017

ABCD, arq. bras. cir. dig.

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Introduction: Liver transplantation is intended to increase the survival of patients with chronic liver disease in terminal phase, as well as improved quality of life. Since the first transplant until today many changes have occurred in the organ allocation system. Objective:To review the literature on the Model for End-stage Liver Disease (MELD) and analyze its correlation with survival after liver transplantation. Method:An integrative literature review in Lilacs, SciELO, and Pubmed in October 2015, was realized. Were included eight studies related to the MELD score and its impact on liver transplant. Results:There was predominance of transplants in male between 45-55 y. The main indications were hepatitis C, hepatocellular carcinoma and alcoholic cirrhosis. The most important factors post-surgery were related to the MELD score, the recipient age, expanded donor criteria and hemotransfusion. Conclusion:The MELD system reduced the death rate in patients waiting for a liver transplant. However, this score by itself is not a good predictor of survival after liver transplantation.

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“…The major controversy following the implementation of MELD is the balance in organ allocation between reduced waitlist mortality and the best posttransplantation outcome [ 9 ]. Numerous studies have investigated, with varying results, the prognostic value of the MELD score for early and late posttransplant survival [ 3 , 10 , 11 ]. At our centre, the recipients with a MELD score between 20 and 29 received organs fulfilling at least one extended donor criterion significantly more frequently.…”

Section: Discussionmentioning

confidence: 99%

“…MELD was calculated at the time of transplantation, as previously described [ 3 ], using the following objective variables: the serum creatinine, bilirubin, and INR levels. The minimum acceptable value for INR, creatinine, and bilirubin is 1.…”

Section: Methodsmentioning

confidence: 99%

The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo, Brazil

Chaib

Massad

Varone³

et al. 2014

Journal of Transplantation

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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.

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A seleção de pacientes utilizando-se o critério meld melhora a sobrevida a curto prazo dos pacientes submetidos ao transplante de fígado?

Abstract: The MELD score have significantly improved short-term survival for the sickest patient on the waiting list for liver transplantation; additionally, it does not have any significant impact in survival for the healthiest patient.

Cited by 10 publications

References 7 publications

Thromboelastographic reference ranges for a cirrhotic patient population undergoing liver transplantation

Quality of life after liver transplantation with old donor graft

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

The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo, Brazil

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