The impact of the model for end-stage liver disease (MELD) on liver transplantation in one center in Brazil

Abstract

-Context -Presently the MELD score is used as the waiting list criterion for liver transplantation in Brazil. In this method more critical patients are considered priority to transplantation. Objective -To compare the results of liver transplantation when the chronologic waiting list was the criterion for organ allocation (pre-MELD era) with MELD score period (MELD era) in one liver transplantation unit in Brazil. Methods -The charts of the patients subjected to liver transplantation at the Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, Brazil, were reviewed from January of 2001 to August of 2008. Patients were divided into two groups: pre-MELD era and MELD era. They were compared in relation to demographics of donors and receptors, etiology of cirrhosis, cold and warm ischemia time, presence of hepatocellular carcinoma, MELD score and Child-Pugh score and classification at the time of transplantation, units of red blood cells transfused during the transplantation, intensive care unit stay, total hospital stay and 3 month and 1 year survival. Results -Initially, 205 liver transplantations were analyzed. Ninety four were excluded and 111 were included: 71 on the pre-MELD era and 40 on the MELD era. The two groups were comparable in relation to donors and receptors age and sex, etiology of cirrhosis and cold and warm ischemia time. The receptors of the MELD era had more hepatocellular carcinoma than those of the pre-MELD era (37.5% vs 16.9%). Patients with hepatocellular carcinoma had less advanced cirrhosis on both eras. The MELD score was the same on both eras. Excluding the cases of hepatocellular carcinoma, MELD era score was higher than pre-MELD score (18.2 vs 15.8). There were an increased number of transplants on Child-Pugh A and C and a decreased number on Child-Pugh B receptors on MELD era. Both eras had the same need of red blood cells transfusion, intensive care unit stay and hospital stay. Also, 3 month and 1 year survival were the same: 76% and 74.6% on pre-MELD era and 75% and 70.9% on MELD era. Conclusion -In our center, after the introduction of MELD score as the priority criterion for liver transplantation there were an increased number of transplants with hepatocellular carcinoma. Excluding these patients, the receptors were operated upon with more advanced cirrhosis. Nevertheless the patients had the same need for red blood cells transfusion, intensive care unit and hospital stay and 3 months and 1 year survival.

Analysis of the Survival of Cirrhotic Patients Enlisted for Liver Transplantation in the Pre- And Post-Meld Era in Southern Brazil

“…Both these remarks could reinforce that the reported trend in listing and transplanting less alcoholic patients might be positive to the system as a whole. However, when considering the increase in listing and transplanting cases of HCC, which has already been shown by some studies (14,15,37) , there could be a concern that survival would be impaired. In fact, some authors have demonstrated that HCC was an independent risk factor for post-transplant mortality in a long term analysis (38) , and others have shown that the liver cancer transplanted patients had twice the risk of death than their pairs (5) .…”

The Impact of the Meld Score on Liver Transplant Allocation and Results: An Integrative Review

“…Hepatocellular carcinoma did not correlate with a worse survival rate and cases that were not in an advanced stage were found to be associated with lower postoperative morbidity and mortality 11 , 17 . One study 16 found hepatocellular carcinoma to be a risk factor for higher mortality within five years.…”

“…Blood transfusion is also linked to reduced survival after transplantation 2 , 11 , with an association between multiple transfusions and complications seen as a predictor of survival 3 . …”

MELD-Albumin score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units

“…The Model for End-Stage Liver Disease (MELD) score, which is based on the international normalised ratio (INR), and total bilirubin and creatinine levels and re ects liver and kidney function, is widely used as a prognostic marker in patients with liver and heart disease [8,9]. Moreover, the MELD-XI, a modi ed version of the MELD that does not include the INR, which may vary in patients on anticoagulants, is a useful tool for predicting outcome in various cardiovascular diseases and interventions [9,10].…”