Model for end-stage liver disease-based allocation system for liver transplantation in Argentina: does it work outside the United States?

Abstract

After MELD implementation, WL mortality increased and most patients who died had a low MELD score. A comprehensive revision of the MELD system must be performed to include cultural and socio-economical variables that could affect each country individually.

Liver Transplantation Using Chagas-Infected Donors in Uninfected Recipients: A Single-Center Experience Without Prophylactic Therapy

“…The median hospital stay of this series was 9 days (range: 6-19). The median follow-up was 14 months (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. One patient died on postoperative day 17 due to sepsis without signs or serological evidence of Chagas infection (i.e.…”

“…As this chronic liver graft limitation will not be solved within coming decades, a recent consensus meeting reinforced the need for a reasonable expansion of the acceptance criteria to include those livers that could generate increased risk of graft failure and could potentially transmit diseases such as donor-derived infections (1). In Argentina, despite the implementation of the MELD score allocation system in 2005, the mortality of patients on the liver waiting list is increasing, and has reached 15% and 25% for elective and emergency candidates, respectively (2,3). This scenario has forced our LT team to relax the deceased donor selection criteria, expanding the liver pool to include those organs from T. cruzi-infected donors (4,5).…”

Is it safe to use a liver graft from a chagas disease-seropositive donor in a human immunodeficiency virus-positive recipient? A case report addressing a novel challenge in liver transplantation

“…Mortality on the waiting list and organ allocation would be less problematic if the shortage of liver grafts did not exist 1, 9. In the last decade in Argentina, despite the increasing number of LT procedures and the implementation of the Model for End‐Stage Liver Disease allocation system, the mortality rate on the liver waiting list for emergency status patients has been stable (approximately 25%) 2. In this scenario, any effort to optimize organ allocation should be accompanied by similar efforts to increase the number of organ donors.…”

“…The organ shortage is a well‐established problem, and it is the most important factor leading to the deaths of patients on liver transplantation (LT) waiting lists worldwide 1‐3. The constant struggle between supply and demand has led LT centers to seek different strategies for increasing the liver pool (eg, the use of extended criteria donors).…”

MELD—good for many, not as good for others … at least for now

“…The success of MELD has captured the interest of the transplant community outside of the United States, and it has now been adopted by many other countries [10][11][12][13]. MELD has also been shown to have utility in predicting outcome in patients suffering from acute liver failure, alcoholic hepatitis, and in patients with chronic liver disease undergoing surgery or experiencing traumatic injury [14][15][16][17][18].…”