• Transplant. Proc. · Oct 2012

    Testing liver allocation in São Paulo, Brazil: the relationship of model for end-stage liver disease implementation with a reduction in waiting-list mortality.

    • P R Salvalaggio, R C Afonso, L A Pereira, and B H Ferraz-Neto.
    • Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. salvalaggio@einstein.br
    • Transplant. Proc. 2012 Oct 1; 44 (8): 2283-5.

    IntroductionIn 2006, the model for end-stage liver disease (MELD) was launched as a new liver allocation system in Sao Paulo, Brazil. We designed this study to assess the results of the new allocation policy on waiting list mortality.MethodsWe reviewed the state of Sao Paulo liver transplant database from July 2003 through July 2009. Patients were divided in those who were transplanted before (pre-MELD group) and those who were transplanted after (post-MELD group) the implementation of the MELD system. Included were adult liver transplant candidates. Waiting list mortality was the primary endpoint.ResultsThe unadjusted death rate in patients on the waiting list decreased significantly after the implementation of the MELD system (from 91.2 to 33.5/1000 patients/year, P < .0001). Multivariate analysis has shown a significant drop of the risk of waiting list death for post-MELD patients (odds ration 0.34, P < .0001).ConclusionThere was a reduction in waiting time and list mortality after the implementation of the MELD system in Brazil. Patients listed in the post-MELD era had a significant reduction of death risk on the waiting list. Future studies should assess posttransplant outcomes.Copyright © 2012. Published by Elsevier Inc.

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