O sistema MELD e a mortalidade em lista de espera para transplante de fígado em países em desenvolvimento: lições aprendidas em São Paulo

Abstract

There was a reduction in waiting time and list mortality after implementation of the MELD system in São Paulo. Patients listed in the post-MELD era had a significant reduction in risk for the waiting list mortality. There were no changes in post-transplant outcomes. MELD can be successfully utilized for liver transplant allocation in developing countries.

Hospital do Rim, São Paulo: A World Leader in Kidney Transplantation

“…In Brazil, in contrast, 48% of patients are transplanted within 1-year of being listed and only 3% of patients die while on the waiting list. 4,6 Although there is significant regional disparity in organ allocation, Brazil has still achieved what the United States is still struggling to conceive: an organized and unified methodology for public outreach that increases awareness about identification of organ donors and establishes protocols for organ procurement and allocation. 7 Earlier this year, France made global headlines by joining the cohort of countries with "opt-out" organ donation policies, a step that will both increase their number of available donor organs while reinforcing the nation's stance on the importance of organ donation and transplantation.…”

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

“…Cirrhotic patients with single nodule up to 5 cm or up to three nodules being the largest up to 3 cm, with no macrovascular invasion or detectable metastasis had a survival rate of 75% in four years 21 . The concepts identified in this study have been widely adopted and reproduced in transplant centers in the world, including Brazil, where the good results of survival in this population was reproduced 6 , 9 , 14 , 20 , 21 , 24 . However, only a small portion of patients with HCC fit into the MC, stimulating the development of expanded criteria, with satisfactory results 28 .…”

“…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 .…”

Specialist Service in Liver Transplant in a University Hospital: A Case Study

“…In the logic of the importance of the involvement of the different professionals in this process, studies 5,[17][18] emphasize that the patient's trajectory, from entering the organ waiting list, to performing the transplant, is permeated by a process of questioning and clinical, physical, behavioral and cultural evaluations, and the life of the patients, after the transplant, has implications with changes in their daily life and also that of their family. 17 The research participants emphasize the importance of the existence of the service in the HU, since it is possible to continue the care after the diagnosis of the disease, establishing the transplant therapy with the team that performed it, without the need to refer the patient to another service:…”

“…2 World-wide experiments confirm the success of liver transplantation as a definitive cure for hepatocellular carcinoma, the seventh most common type of cancer worldwide since it allows the total removal of the tumor, [3][4] and is also indicated for patients with decompensated cirrhosis and acute liver failure. 5 The Brazilian public health system offers free and unrestricted access to services for the entire population who requires organs and tissues transplants. 6 The country has one of the largest public transplant programs in the world with a policy based on Laws N. 9,434 / 1997 and N. 10,211 / 2001, which include free donation, beneficence towards recipients and non-maleficence in relation to living donors.…”