Mattos Ângelo Zambam de, Mattos Angelo Alves de, Sacco Fernanda Karlinski Fernandes, Hoppe Lísia, Oliveira Denise Maria Sarti de
Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.
Hospital São Vicente de Paulo, Passo Fundo, RS, Brasil.
Arq Gastroenterol. 2014 Jan-Mar;51(1):46-52. doi: 10.1590/s0004-28032014000100010.
Transplantation is the only cure for decompensated cirrhosis. Model for End-Stage Liver Disease (MELD) is used in liver allocation.
Comparing survival of enlisted populations in pre- and post-MELD eras and estimating their long-term survival.
This is a retrospective study of cirrhotics enlisted for transplantation during pre- and post-MELD eras. Survival curves were generated using Kaplan-Meier's model. Cox's model was used to determine risk factors for mortality. Exponential, Weibull's, normal-log and Gompertz's models were used to estimate long-term survival.
The study included 162 patients enlisted in pre-MELD era and 184 in post-MELD period. Kaplan-Meier's survival curve of patients enlisted in post-MELD era was better than that of pre-MELD period (P = 0.009). This difference remained for long-term estimates, with a survival of 53.54% in 5 years and 44.64% in 10 years for patients enlisted in post-MELD era and of 43.17% and 41.75% for pre-MELD period. Era in which patients had been enlisted (P = 0.010) and MELD score at enlistment (P<0.001) were independently associated to survival with hazard ratios of 0.664 (95% CI-confidence interval = 0.487-0.906) and 1.069 (95% CI = 1.043-1.095).
MELD-based transplantation policy is superior to chronology-based one, promoting better survival for enlisted patients, even in long-term.
肝移植是失代偿期肝硬化的唯一治愈方法。终末期肝病模型（MELD）用于肝脏分配。
比较MELD时代前后登记入组人群的生存率，并估计他们的长期生存率。
这是一项对MELD时代前后登记入组进行肝移植的肝硬化患者的回顾性研究。使用Kaplan-Meier模型生成生存曲线。Cox模型用于确定死亡风险因素。使用指数模型、Weibull模型、正态对数模型和Gompertz模型估计长期生存率。
该研究纳入了162例MELD时代前登记入组的患者和184例MELD时代后登记入组的患者。MELD时代后登记入组患者的Kaplan-Meier生存曲线优于MELD时代前（P = 0.009）。这种差异在长期估计中仍然存在，MELD时代后登记入组的患者5年生存率为53.54%，10年生存率为44.64%，而MELD时代前分别为43.17%和41.75%。患者登记入组的时代（P = 0.010）和登记入组时的MELD评分（P<0.001）与生存率独立相关，风险比分别为0.664（95%置信区间= 0.487 - 0.906）和1.069（95%置信区间= 1.043 - 1.095）。
基于MELD的移植政策优于基于时间顺序的政策，即使在长期也能提高登记入组患者的生存率。
