Análisis del sistema de alistamiento y priorización para trasplante hepático de adultos en Chile

Abstract

cARlos deRosAs 8 , susAnA elguetA 9 comité asesor para alistamiento y priorización para trasplante hepático en chile Analysis of the organ allocation system for liver transplantation in Chile Background: In Chile, organ allocation for liver transplantation (LT) in adults is prioritized according to the MELD-Na score. Exceptions such as Hepatocellular Carcinoma (HCC) and other non-HCC exceptions receive a score called Operational MELD score. Aim: To evaluate the effectiveness of the MELD-Na score and the operational MELD score as a prioritization system for LT in Chile. Material and Methods: Retrospective analysis of the waiting list (WL) of adult candidates (≥ 15 years) for elective LT in Chile from 2011 to 2017. The probability of leaving the WL, defined by death or contraindication for LT was compared in three groups: 1) Cirrhotic patients prioritized according to their real MELD-Na score (CPM), 2) HCC and 3) other non-HCC exceptions. Results: We analyzed 730 candidates for LT, with a median age of 57 years, 431 (56%) were men. In the study period, 352 LT were performed (48%). The annual exit rate was significantly higher in the CPM group (45.5%) compared to HCC (33.1%) and non-HCC (29.3%), (p < 0.001). Post LT survival was 86% at 1 year and 85% at 5 years, without significant differences between groups. In the CPM group, post-transplant survival was significantly lower (p < 0.05) in patients with MELD-Na ≥ 30 at transplant (81% per year) compared to patients with patients with MELD-Na < 30 (91% per year). Conclusions: MELD-Na score can discriminate very well patients who have a higher risk of death in the short and medium term. However, the assignment of operational scores for situations of exception produces inequities in the allocation of organs for LT and must therefore be carefully adjusted.

Prevalence of non-alcoholic fatty liver disease and its association with lifestyle habits in adults in Chile: a cross-sectional study from the National Health Survey 2016–2017

“…Based on data from Colombia and Brazil, the prevalence of NAFLD in South America seems higher than elsewhere (2,43) . In Chile, NAFLD appears as the main cause of liver transplant and liver cancer (44) . Until now, however, the prevalence of NAFLD in adults in Chile was unknown.…”

Liver transplantation in Latin America: reality and challenges

“…Although a higher mortality in patients with higher MELD scores justifies its use, inequities from exception scenarios have been observed in Chile, which warrant further adjustment. 27 Also, the MELD/PELD system has resulted in reduced access to LT in paediatric candidates under two years, with considerable waitlist mortality. 18 In February 2022, 186 patients were waiting to receive a LT. 52 The Hospital Clínico de la Universidad Católica de Chile is the leading center in the country with 66 LT and 19 LDLT in 2022, becoming since 2018, one of the largest LDLT centers in Latin America, with a total of 82 LDLT so far.…”

Esteatohepatitis no-alcohólica: Desarrollo silencioso de una emergencia en salud pública

“…Importante, aproximadamente el 20% de los casos de HGNA progresa a Esteatohepatitis no-alcohólica 4 . Esta progresión es la principal causa de cirrosis, trasplante de hígado, y cáncer hepatocelular en Chile 5 . En el día mundial de la Esteatohepatitis no-alcohólica, hacemos un llamado de atención por la emergencia sanitaria a la que el aumento de casos de HGNA y Esteatohepatitis no-alcohólica en Chile puede llevar.…”