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

Abstract

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.

Liver Transplantation in Brazil

“…The implementation of MELD shortened waiting times to LT, reduced wait‐list mortality, and increased the number of LTs performed in adults for HCC. No significant decline has been observed in postoperative survival rates . Extra MELD points are assigned for HCC, other primary liver tumors, and metabolic diseases .…”

“…No significant decline has been observed in postoperative survival rates. (11)(12)(13)(14) Extra MELD points are assigned for HCC, other primary liver tumors, and metabolic diseases. (10) Complications such as refractory ascites, pruritus, persistent or recurrent hepatic encephalopathy, and recurrent cholangitis are considered special situations when severe and may be granted MELD exception points by the National Technical Committee of Liver 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 .…”

Avaliação do tratamento dos nódulos do hepatocarcinoma nos pacientes em lista de espera para transplante hepático

“…Cirrhotic patients with a single nodule up to 5 cm or up to three nodules, the largest of up to 3cm, with no macrovascular invasion or detectable metastases, presented survival of 75% in four years 2 . The concepts identified in this study were widely adopted and reproduced In the major transplant centers in the world, including Brazil, which reproduced the good survival results of that population 3,4 . However, only a small proportion of HCC patients fit the MC 5 .…”