Post Graduate Program in Medicine-Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil.
Ann Hepatol. 2013 May-Jun;12(3):440-7.
Introduction. Model for end-stage liver disease (MELD) is an accurate predictor of mortality in patients with cirrhosis, and has been used on liver allocation in Brazil since 2006. However, its impact on organ allocation, waiting list and post-transplant mortality is still poorly characterized. This study aimed to assess the impact of implementation of the MELD system on liver allocation and mortality after liver transplantation (LT) in Southern Brazil. Material and methods. Adult patients with chronic liver disease on the waiting list for primary deceased-donor LT were divided into two cohorts (pre- and post-MELD implementation) according to the date of waiting list placement. Disease severity, as assessed by MELD score at placement, was similar in both cohorts. Patients were followed for at least 18 months to assess the outcomes of interest (death/LT). Results. Higher MELD scores correlated with waiting list mortality, which increased 20% with each additional point (HR 1.2; 95%CI 1.14-2.26; p < 0.001). Waiting list mortality was 30.9% before and 21.7% after MELD implementation (nonsignificant). Transplant rate increased after MELD implementation (52 vs. 40%, p = 0.002). After excluding patients with hepatocellular carcinoma, mean MELD scores at LT were significantly higher in the MELD era (p < 0.01). There was no significant correlation between MELD scores at LT and post-LT survival. During 18-month follow-up, post-LT mortality rate was 25.4% before and 20% after MELD implementation (nonsignificant). Conclusion. MELD implementation was associated with a reduction in waiting list mortality. Although sicker patients received LT in the MELD era, post-transplant survival was similar in both periods.
简介。终末期肝病模型（MELD）是预测肝硬化患者死亡率的准确指标，自 2006 年以来，该模型已用于巴西的肝脏分配。然而，其对器官分配、等待名单和移植后死亡率的影响仍未得到充分描述。本研究旨在评估 MELD 系统的实施对巴西南部肝脏分配和肝移植（LT）后死亡率的影响。
材料和方法。根据等待名单放置日期，将慢性肝病成年患者分为两个队列（MELD 实施前和实施后）。两组患者的疾病严重程度（MELD 评分）相似。至少随访 18 个月以评估感兴趣的结局（死亡/LT）。
结果。MELD 评分越高，等待名单死亡率越高，每增加 1 分死亡率增加 20%（HR 1.2；95%CI 1.14-2.26；p < 0.001）。MELD 实施前等待名单死亡率为 30.9%，实施后为 21.7%（无显著性差异）。MELD 实施后移植率增加（52%对 40%，p = 0.002）。排除肝细胞癌患者后，MELD 时代 LT 时的平均 MELD 评分显著升高（p < 0.01）。LT 时的 MELD 评分与 LT 后生存率无显著相关性。在 18 个月的随访期间，MELD 实施前的 LT 后死亡率为 25.4%，实施后为 20%（无显著性差异）。
结论。MELD 的实施与降低等待名单死亡率相关。尽管 MELD 时代接受 LT 的患者病情更严重，但两个时期的移植后生存率相似。
