Pestana R C, Baracat E I, Massarollo P C B, Pereira L A, Szutan L A
Service of Liver Transplantation, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
Transplant Proc. 2013 Jul-Aug;45(6):2111-4. doi: 10.1016/j.transproceed.2012.11.007. Epub 2013 Jun 5.
In July 2006, the system for liver allocation in Brazil started to rely on the Model for End-stage Liver Disease (MELD) scale, replacing the previous chronological criteria. Under the new system, the score for listing pediatric patients is obtained by multiplication of the calculated PELD score by 3. The current criteria also features extra points for diseases such as hepatocellular carcinoma (HCC). This study sought to analyze the consequences of implementation of the MELD system on waiting list mortality, posttransplant survival rates and characteristics of the transplanted patients.
We retrospectively studied data from the State Health Secretariat of São Paulo, regarding all patients registered on the waiting list for liver transplantation in the State of São Paulo, in two periods: July 2005 to July 2006 (pre-MELD era) and July 2006 to July 2010 (MELD era). Patient survival rates calculated using the Kaplan-Meier method were compared by the log-rank test. P values <.05 were considered statistically relevant.
After implementation of the MELD, waiting list registrations decreased by 39.8%; the percentage of transplants in HCC recipients increased from 2.4% to 23.7%; pediatric transplants increased from 6.5% to 9.3%; deaths on the list fell from 599 in the pre-MELD era to 359 in the last year analyzed; recipients with higher MELD displayed significantly lower posttransplant survival rates; HCC patients, better survival after transplantation (P = .002); No difference was observed comparing survival rates between pre-MELD and MELD eras (P = 474) or between adults and children (P = .867).
Under the MELD system for liver allocation in Brazil, there was a reduction in waiting list mortality and an increased number of transplantations in pediatric and HCC recipients. Survival rates of patients with higher MELD score were inferior. However, this result was offset by the greater survival in HCC recipients, with no difference in patient survival rates between the pre-MELD and MELD eras.
2006年7月，巴西的肝脏分配系统开始采用终末期肝病模型（MELD）评分系统，取代了之前按时间顺序排列的标准。在新系统下，儿科患者的登记分数是通过将计算出的PELD分数乘以3获得的。当前标准还对肝细胞癌（HCC）等疾病给予额外加分。本研究旨在分析实施MELD系统对等待名单死亡率、移植后生存率以及移植患者特征的影响。
我们回顾性研究了圣保罗州卫生秘书处的数据，涉及圣保罗州在两个时间段内登记在肝脏移植等待名单上的所有患者：2005年7月至2006年7月（MELD时代之前）和2006年7月至2010年7月（MELD时代）。使用Kaplan-Meier方法计算的患者生存率通过对数秩检验进行比较。P值<.05被认为具有统计学意义。
实施MELD后，等待名单登记人数减少了39.8%；HCC受者的移植百分比从2.4%增加到23.7%；儿科移植从6.5%增加到9.3%；等待名单上的死亡人数从MELD时代之前的599人降至分析的最后一年的359人；MELD评分较高的受者移植后的生存率显著较低；HCC患者移植后生存率较好（P =.002）；在比较MELD时代之前和MELD时代的生存率（P = 474）或成人和儿童的生存率（P =.867）时未观察到差异。
在巴西的肝脏分配MELD系统下，等待名单死亡率降低，儿科和HCC受者的移植数量增加。MELD评分较高的患者生存率较低。然而，这一结果被HCC受者更高的生存率所抵消，MELD时代之前和MELD时代患者的生存率没有差异。
