Comparação da evolução do transplante hepático em receptores com MELD alto e baixo

OBJECTIVE: To compare low and high MELD scores and investigate whether existing renal dysfunction has an effect on transplant outcome. METHODS: Data was prospectively collected among 237 liver transplants (216 patients) between March 2003 and March 2009. Patients with cirrhotic disease submitted to transplantation were divided into three groups: MELD &gt; 30, MELD < 30, and hepatocellular carcinoma. Renal failure was defined as a ± 25% decline in estimated glomerular filtration rate as observed 1 week after the transplant. Median MELD scores were 35, 21, and 13 for groups MELD &gt; 30, MELD < 30, and hepatocellular carcinoma, respectively. RESULTS: Recipients with MELD &gt; 30 had more days in Intensive Care Unit, longer hospital stay, and received more blood product transfusions. Moreover, their renal function improved after liver transplant. All other groups presented with impairment of renal function. Mortality was similar in all groups, but renal function was the most important variable associated with morbidity and length of hospital stay. CONCLUSION: High MELD score recipients had an improvement in the glomerular filtration rate after 1 week of liver transplantation

The MELD system and liver transplant waiting-list mortality in developing countries: lessons learned from São Paulo, Brazil

Objective: The MELD system has not yet been tested as an allocationtool for liver transplantation in the developing countries. In 2006,MELD (Model for End-stage Liver Disease) was launched as a newliver allocation system in São Paulo, Brazil. This study was designedto assess the results of the new allocation policy on waiting listmortality. Methods: The State of São Paulo liver transplant databasewas retrospectively reviewed from July 2003 through July 2009.Patients were divided into those who were transplanted before (Pre-MELD Group) and those who were transplanted after (post-MELDGroup) the implementation of the MELD system. Only adult livertransplant candidates were included. Waiting list mortality was theprimary endpoint. Results: The unadjusted death rate in waiting listdecreased significantly after the implementation of the MELD system(from 91.2 to 33.5/1,000 patients per year; p<0.0001). Multivariateanalysis showed a significant drop in risk of waiting list death forpost-MELD patients (HR 0.34; p<0.0001). Currently, 48% of patientsare transplanted within 1-year of listing (versus 23% in the pre-MELDera; p<0.0001). Patient and graft survival did not change with MELDimplementation. Conclusion: There was a reduction in waiting timeand list mortality after implementation of the MELD system in SãoPaulo. Patients listed in the post-MELD era had a significant reduction in risk for the waiting list mortality. There were no changes in posttransplant outcomes. MELD can be successfully utilized for liver transplant allocation in developing countries

Liver transplant outcome: a comparison between high and low MELD score recipients

OBJECTIVE: To compare low and high MELD scores and investigate whether existing renal dysfunction has an effect on transplant outcome. METHODS: Data was prospectively collected among 237 liver transplants (216 patients) between March 2003 and March 2009. Patients with cirrhotic disease submitted to transplantation were divided into three groups: MELD &gt; 30, MELD < 30, and hepatocellular carcinoma. Renal failure was defined as a ± 25% decline in estimated glomerular filtration rate as observed 1 week after the transplant. Median MELD scores were 35, 21, and 13 for groups MELD &gt; 30, MELD < 30, and hepatocellular carcinoma, respectively. RESULTS: Recipients with MELD &gt; 30 had more days in Intensive Care Unit, longer hospital stay, and received more blood product transfusions. Moreover, their renal function improved after liver transplant. All other groups presented with impairment of renal function. Mortality was similar in all groups, but renal function was the most important variable associated with morbidity and length of hospital stay. CONCLUSION: High MELD score recipients had an improvement in the glomerular filtration rate after 1 week of liver transplantation