Tenório A L, Macedo F I B, Miranda L E C, Fernandes J L, da Silva C M, Neto O L F, Lacerda C M
Department of Surgery and Liver Transplantation, Oswaldo Cruz University Hospital, University of Pernambuco School of Medicine, Recife, Brazil.
Transplant Proc. 2010 Mar;42(2):407-11. doi: 10.1016/j.transproceed.2010.01.005.
Since July 2006, the Model for End-stage Liver Disease (MELD) score has served as the national basis for allocation of donor livers for transplantation in Brazil. Patients with higher MELD scores receive greater priority for allocation regardless of the time on the waiting list.
To investigate the impact of MELD score implementation on the survival of waiting list patients.
A retrospective study of patients registered at the national Organ Procurement Organization (OPO) for the liver transplantation waiting list between January 2004 and June 2006 (pre-MELD) and between July 2006 and December 2008 (post-MELD).
We included listed patients awaiting liver transplantation in the pre-MELD era (n = 250, 48.4%) and in the post-MELD era (n = 266, 51.6%). The times awaiting transplant prior to and after the MELD system were 487.2 +/- 384.8 days and 183.9 +/- 157.2 days, respectively. Prior to the MELD score, waiting list survivals were greater when compared to rates in the current system. Early posttransplant patient survival rates were significantly reduced in the post-MELD era (83.4%) compared to the period before MELD implementation (93.2%).
MELD score provides a transparent, objective system to drive allocation policy; however, it presents several important limitations. Constant need of changes and reevaluation are needed as an evolutionary process. Future changes in the present system may be addressed by adjusting the MELD system.
自2006年7月起，终末期肝病模型（MELD）评分一直是巴西全国范围内分配供肝用于移植的依据。MELD评分较高的患者在分配中享有更高的优先级，而不考虑其在等待名单上的时间。
研究实施MELD评分对等待名单上患者生存的影响。
对2004年1月至2006年6月（MELD实施前）以及2006年7月至2008年12月（MELD实施后）期间在国家器官获取组织（OPO）登记进入肝移植等待名单的患者进行回顾性研究。
我们纳入了MELD实施前时代等待肝移植的患者（n = 250，48.4%）和MELD实施后时代的患者（n = 266，51.6%）。MELD系统实施前后的等待移植时间分别为487.2±384.8天和183.9±157.2天。在MELD评分实施前，等待名单上的生存率高于当前系统中的生存率。与MELD实施前的时期（93.2%）相比，MELD实施后时代移植后早期患者生存率显著降低（83.4%）。
MELD评分提供了一个透明、客观的系统来推动分配政策；然而，它存在一些重要局限性。作为一个演进过程，需要不断进行改变和重新评估。当前系统未来的变化可通过调整MELD系统来解决。
