Results after the adoption of a <scp>MELD</scp>/<scp>PELD</scp>‐based liver allocation policy in Argentina

Dip, Marcelo; Cejas, N; Cervio, Guillermo; Villamil, Federico; Tagliafichi, Viviana; Krogh, Daniela Hansen; Imventarza, Oscar; Soratti, Carlos; Bisigniano, Liliana

doi:10.1111/petr.12395

Cited by 9 publications

(13 citation statements)

References 12 publications

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“…Analyzing the pre‐ and post‐PELD eras, there was a 44% increase in the waiting list, as well as the number of liver transplants performed increased by 24%. Waiting list mortality rates lowered from 32% to 18%, comparing pre‐ and post‐PELD eras . Also interesting was the change in the baseline disease that indicated the liver transplant over the last decade: The emergency etiology has abruptly lowered since the universal Hepatitis A vaccine was instituted in 2005 National organization websites do not provide survival data or waiting list mortality data .…”

Section: Resultsmentioning

confidence: 99%

“…Seda-Neto et al showed, in a cohort of 430 Data from the World Health Organization (1) and IroDat (7). comparing pre-and post-PELD eras (17 (7), the deceased donor transplantation rate was only 3.71 pmp in 2013, not much different from previous years. This is in part secondary to the lack of federal funding for donation and transplantation activities and the fragmentation of the healthcare system.…”

Section: Brazilmentioning

confidence: 87%

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Pediatric liver transplantation in Latin America: Where do we stand?

Feier

Antunes

D’Agostino

et al. 2016

Pediatric Transplantation

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LT started in LA in 1968, and pediatric LT records are available starting in the 1990s. Currently, eight countries perform pediatric LT in LA. Registries by national organizations fail to report robust data on pediatric LT. The aim of this paper was to report on the pediatric LT activity in LA. Data were gathered retrospectively through information available in the national registries websites and from local centers. Of the eight countries that report pediatric LT activity, Brazil, Argentina, Mexico, and Colombia have adequate registries of the numbers of LT performed. These countries concentrate most of the activity for pediatric LT. A total of 4593 pediatric LT were reported in LA. Websites for national organizations do not provide open data on post-transplant survival rates or waiting list mortality. The information herein is based on reports by local centers. Overall, survival from select centers is similar to that reported on North American and European registries, between 80 and 90% in the first year post-transplant. In conclusion, pediatric LT activity is growing in LA, especially in Brazil and Argentina. However, the lack of an appropriate LA registry restricts the assessment of quality and therefore restricts interventions aimed at quality improvements in different regions.

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Section: Resultsmentioning

confidence: 99%

Section: Brazilmentioning

confidence: 87%

Pediatric liver transplantation in Latin America: Where do we stand?

Feier

Antunes

D’Agostino

et al. 2016

Pediatric Transplantation

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“…For data analysis, two groups were compared: CLD patients with accepted PELD/MELD exceptions (exception PELD/MELD Group) compared to non‐exception CLD patients with a PELD/MELD score ≥19 points (PELD/MELD group). Dip et al showed that the cutpoint that best discriminated between alive and dead patients on the WL at 3 months in Argentina was a calculated PELD of 19 with a sensitivity of 83.2 and a specificity of 83.3. Primary outcomes were as follows: (i) liver transplant accessibility (transplants/listed patients), (ii) WL mortality (deaths/listed patients), (iii) total dropout (removals because of death + too sick/listed patients) and (iv) post‐transplant patient survival.…”

Section: Methodsmentioning

confidence: 99%

“…These scoring systems are based on an objective formula that accurately predicts the mortality of patients with CLD at 3, 6, 9, and 12 months . Using this allocation system, WL mortality has decreased significantly in adult and pediatric patients with CLD . There is now an increasing number of older, clinically severe adults on the WL for LT, which, coupled with a shortage of donors, leads to competition with the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

“…2 Using this allocation system, WL mortality has decreased significantly in adult and pediatric patients with CLD. [2][3][4] There is now an increasing number of older, clinically severe adults on the WL for LT, which, coupled with a shortage of donors, leads to competition with the pediatric population. This dynamic in the evolution of the WL is similar to that reported in countries such as the United States and is the main cause that has forced pediatric liver transplant centers to use the exceptional pathways as a competitive strategy.…”

Section: Introductionmentioning

confidence: 99%

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Waiting list outcome of Peld/Meld exceptions: A single‐center experience in Argentina

Lauferman

Dip

Halac

et al. 2018

Pediatric Transplantation

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As PELD/MELD-based allocation policy was adopted in Argentina in 2005, a system of exception points has been in place in order to award increased waitlist priority to those patients whose severity of illness is not captured by the PELD/MELD score. We aimed to investigate the WL outcome of patients with granted PELD/MELD exceptions. A retrospective cohort study was conducted in children under 18 years old. WL outcomes were evaluated using univariable analysis. From 07/2005 to 01/2014, 408 children were listed for LT. There were 304 classified by calculated PELD/MELD. During this time, 85 (30%) PELD/MELD exceptions were granted. In this cohort, 89.4% (76 of 85) were transplanted and 7.1% (6 of 85) died while on the WL. The remaining 3 pts (3.5%) were removed from the WL due to other causes. We compared the impact of PELD/MELD exceptions in those 85 patients to outcomes in 87 non-exception patients with PELD/MELD ≥19 points. Patients with the exception had significantly better access to WL and lower WL mortality. Our data suggest that children listed by PELD/MELD exceptions had an advantage compared to children with CLD with equivalent PELD/MELD listing priorities.

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Split liver transplantation: Report of right and left graft outcomes from a multicenter Argentinean group

Halac

Dip

Quiñonez³

et al. 2015

Liver Transpl

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Grafts from split livers (SLs) constitute an accepted approach to expand the donor pool. Over the last 5 years, most Argentinean centers have shown significant interest in increasing the use of this technique. The purpose of this article is to describe and analyze the outcomes of right-side grafts (RSGs) and left-side grafts (LSGs) from a multicenter study. The multicenter retrospective study included data from 111 recipients of SL grafts from between January 1, 2009 and December 31, 2013. Incidence of surgical complications, patient and graft survival, and factors that affected RSG and LSG survival were analyzed. Grafts types were 57 LSG and 54 RSG. Median follow-up times for LSG and RSG were 46 and 42 months, respectively. The 36-month patient and graft survivals for LSG were 83% and 79%, respectively, and for RSG were 78% and 69%, respectively. Retransplantation rates for LSG and RSG were 3.5% and 11%, respectively. Arterial complications were the most common cause of early retransplantation (less than 12 months). Cold ischemia time (CIT) longer than 10 hours and the use of high-risk donors (age 40 years or body mass index 30 kg/m 2 or 5 days intensive care unit stay) were independent factors for diminished graft survival in RSG. None of the analyzed variables were associated with worse graft survival in LSG. Biliary complications were the most frequent complications in both groups (57% in LSG and 33% in RSG). Partial grafts obtained from liver splitting are an excellent option for patients in need of liver transplantation and have the potential to alleviate the organ shortage. Adequate donor selection and reducing CIT are crucial for optimizing results. Liver transplantation (LT) performed with split liver (SL) grafts may currently be considered a safe and effective resource to alleviate the organ shortage. Over the past years, multiple review articles have shown results that are similar to those obtained in transplantations performed with whole organs. [1][2][3][4] Nevertheless, in the majority of countries, the strategy remains underused, despite its known potential to decrease mortality on the pediatric waiting list without harming adults waiting for LT, resulting in a net benefit for health care systems by providing the possibility to optimize the use of a scarce resource. [5][6][7] Over the last 5 years in most Argentinean centers, there has been significant interest in increasing the use of this technique.The aim of this study was to report the results of SL transplantations over the past 5 years in Argentina

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Results after the adoption of a MELD/PELD‐based liver allocation policy in Argentina

Cited by 9 publications

References 12 publications

Pediatric liver transplantation in Latin America: Where do we stand?

Pediatric liver transplantation in Latin America: Where do we stand?

Waiting list outcome of Peld/Meld exceptions: A single‐center experience in Argentina

Split liver transplantation: Report of right and left graft outcomes from a multicenter Argentinean group

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