Salvalaggio Paolo, Afonso Rogerio Carballo, Pereira Luiz Augusto, Ferraz-Neto Ben-Hur
Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
Einstein (Sao Paulo). 2012 Jul-Sep;10(3):278-85. doi: 10.1590/s1679-45082012000300004.
The MELD system has not yet been tested as an allocation tool for liver transplantation in the developing countries. In 2006, MELD (Model for End-stage Liver Disease) was launched as a new liver allocation system in São Paulo, Brazil. This study was designed to assess the results of the new allocation policy on waiting list mortality.
The State of São Paulo liver transplant database was retrospectively reviewed from July 2003 through July 2009. Patients were divided into those who were transplanted before (Pre-MELD Group) and those who were transplanted after (post-MELD Group) the implementation of the MELD system. Only adult liver transplant candidates were included. Waiting list mortality was the primary endpoint.
The unadjusted death rate in waiting list decreased significantly after the implementation of the MELD system (from 91.2 to 33.5/1,000 patients per year; p<0.0001). Multivariate analysis showed a significant drop in risk of waiting list death for post-MELD patients (HR 0.34; p<0.0001). Currently, 48% of patients are transplanted within 1-year of listing (versus 23% in the pre-MELD era; p<0.0001). Patient and graft survival did not change with MELD implementation.
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.
终末期肝病模型（MELD）系统尚未在发展中国家作为肝移植分配工具进行测试。2006年，MELD（终末期肝病模型）在巴西圣保罗作为一种新的肝分配系统推出。本研究旨在评估新分配政策对等待名单死亡率的影响。
回顾性分析2003年7月至2009年7月圣保罗州肝移植数据库。患者分为MELD系统实施前接受移植的患者（MELD前组）和实施后接受移植的患者（MELD后组）。仅纳入成年肝移植候选者。等待名单死亡率是主要终点。
MELD系统实施后，等待名单上未经调整的死亡率显著下降（从每年91.2/1000例患者降至33.5/1000例患者；p<0.0001）。多变量分析显示，MELD后患者等待名单死亡风险显著降低（风险比0.34；p<0.0001）。目前，48%的患者在列入名单后1年内接受移植（MELD前时代为23%；p<0.0001）。MELD系统实施后，患者和移植物存活率未发生变化。
圣保罗实施MELD系统后，等待时间和等待名单死亡率有所降低。MELD后时代列入名单的患者等待名单死亡风险显著降低。移植后结局无变化。MELD可成功用于发展中国家的肝移植分配。
