Transplant Society of Argentina, Buenos Aires, Argentina.
Liver Transpl. 2013 Jul;19(7):711-20. doi: 10.1002/lt.23665.
In July 2005, Argentina became the first country after the United States to introduce the Model for End-Stage Liver Disease (MELD) for organ allocation. In this study, we investigated waiting-list (WL) outcomes (n = 3272) and post-liver transplantation (LT) survival in 2 consecutive periods of 5 years before and after the implementation of a MELD-based allocation policy. Data were obtained from the database of the national institute for organ allocation in Argentina. After the adoption of the MELD system, there were significant reductions in WL mortality [28.5% versus 21.9%, P < 0.001, hazard ratio (HR) = 1.57, 95% confidence interval (CI) = 1.37-1.81] and total dropout rates (38.6% versus 29.1%, P < 0.001, HR = 1.31, 95% CI = 1.16-1.48) despite significantly less LT accessibility (57.4% versus 50.7%, P < 0.001, HR = 1.53, 95% CI = 1.39-1.68). The annual number of deaths per 1000 patient-years at risk decreased from 273 in 2005 to 173 in 2010, and the number of LT procedures per 1000 patient-years at risk decreased from 564 to 422. MELD and Model for End-Stage Liver Disease-Sodium scores were excellent predictors of 3-month WL mortality with c statistics of 0.828 and 0.857, respectively (P < 0.001). No difference was observed in 1-year posttransplant survival between the 2 periods (81.1% versus 81.3%). Although patients with a MELD score > 30 had lower posttransplant survival, the global accuracy of the score for predicting outcomes was poor, as indicated by a c statistic of only 0.523. Patients with granted MELD exceptions (158 for hepatocellular carcinoma and 52 for other reasons) had significantly higher access to LT (80.4%) in comparison with nonexception patients with equivalent listing priority (MELD score = 18-25; 54.6%, P < 0.001, HR = 0.49, 95% CI = 0.40-0.61). In conclusion, the adoption of the MELD model in Argentina has resulted in improved liver organ allocation without compromising posttransplant survival.
2005 年 7 月，阿根廷成为继美国之后第一个引入终末期肝病模型（MELD）进行器官分配的国家。本研究调查了实施 MELD 分配政策前后连续 5 年的等待名单（WL）结局（n=3272）和肝移植（LT）后生存率。数据来自阿根廷国家器官分配研究所的数据库。采用 MELD 系统后，WL 死亡率显著降低[28.5%比 21.9%，P<0.001，风险比（HR）=1.57，95%置信区间（CI）=1.37-1.81]，总失访率降低[38.6%比 29.1%，P<0.001，HR=1.31，95%CI=1.16-1.48]，尽管 LT 可及性显著降低[57.4%比 50.7%，P<0.001，HR=1.53，95%CI=1.39-1.68]。每 1000 个风险患者年的死亡人数从 2005 年的 273 人减少到 2010 年的 173 人，每 1000 个风险患者年的 LT 例数从 564 例减少到 422 例。MELD 和终末期肝病模型钠评分是 WL 3 个月死亡率的优秀预测指标，C 统计量分别为 0.828 和 0.857（P<0.001）。两个时期的 1 年移植后生存率无差异（81.1%比 81.3%）。尽管 MELD 评分>30 的患者移植后生存率较低，但评分预测结局的整体准确性较差，C 统计量仅为 0.523。获得 MELD 豁免的患者（158 例为肝细胞癌，52 例为其他原因）获得 LT 的机会明显高于具有同等列表优先级（MELD 评分=18-25）的非豁免患者（54.6%，P<0.001，HR=0.49，95%CI=0.40-0.61）。结论，阿根廷采用 MELD 模型进行肝脏器官分配，提高了分配公平性，同时并未降低移植后生存率。
