14 research outputs found
Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil
OBJECTIVE: To analyze the impact of model for end-stage liver disease (MELD) allocation policy on survival outcomes after liver transplantation (LT). INTRODUCTION: Considering that an ideal system of grafts allocation should also ensure improved survival after transplantation, changes in allocation policies need to be evaluated in different contexts as an evolutionary process. METHODS: A retrospective cohort study was carried out among patients who underwent LT at the University of Pernambuco. Two groups of patients transplanted before and after the MELD allocation policy implementation were identified and compared using early postoperative mortality and post-LT survival as end-points. RESULTS: Overall, early postoperative mortality did not significantly differ between cohorts (16.43% vs. 8.14%; p = 0.112). Although at 6 and 36-months the difference between pre-vs. post-MELD survival was only marginally significant (p = 0.066 and p = 0.063; respectively), better short, medium and long-term post-LT survival were observed in the post-MELD period. Subgroups analysis showed special benefits to patients categorized as nonhepatocellular carcinoma (non-HCC) and moderate risk, as determined by MELD score (15-20). DISCUSSION: This study ensured a more robust estimate of how the MELD policy affected post-LT survival outcomes in Brazil and was the first to show significantly better survival after this new policy was implemented. Additionally, we explored some potential reasons for our divergent survival outcomes. CONCLUSION: Better survival outcomes were observed in this study after implementation of the MELD criterion, particularly amongst patients categorized as non-HCC and moderate risk by MELD scoring. Governmental involvement in organ transplantation was possibly the main reason for improved survival
Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil
OBJECTIVE: To analyze the impact of model for endâstage liver disease (MELD) allocation policy on survival outcomes after liver transplantation (LT). INTRODUCTION: Considering that an ideal system of grafts allocation should also ensure improved survival after transplantation, changes in allocation policies need to be evaluated in different contexts as an evolutionary process. METHODS: A retrospective cohort study was carried out among patients who underwent LT at the University of Pernambuco. Two groups of patients transplanted before and after the MELD allocation policy implementation were identified and compared using early postoperative mortality and postâLT survival as endâpoints. RESULTS: Overall, early postoperative mortality did not significantly differ between cohorts (16.43% vs. 8.14%; pâ=â0.112). Although at 6 and 36âmonths the difference between preâ vs. postâMELD survival was only marginally significant (pâ=â0.066 and pâ=â0.063; respectively), better short, medium and longâterm postâLT survival were observed in the postâMELD period. Subgroups analysis showed special benefits to patients categorized as nonâhepatocellular carcinoma (nonâHCC) and moderate risk, as determined by MELD score (15â20). DISCUSSION: This study ensured a more robust estimate of how the MELD policy affected postâLT survival outcomes in Brazil and was the first to show significantly better survival after this new policy was implemented. Additionally, we explored some potential reasons for our divergent survival outcomes. CONCLUSION: Better survival outcomes were observed in this study after implementation of the MELD criterion, particularly amongst patients categorized as nonâHCC and moderate risk by MELD scoring. Governmental involvement in organ transplantation was possibly the main reason for improved survival
Transplante de fĂgado a partir de doadores em assistolia: resultados iniciais do grupo de transplante de fĂgado do Hospital Oswaldo Cruz, Universidade de Pernambuco
OBJETIVO: Relatar a experiĂȘncia inicial do Grupo de Transplante de FĂgado do Hospital UniversitĂĄrio Oswaldo Cruz, Recife - PE, com doadores de fĂgado em assistolia. MĂTODO: Foram revistos os dados referentes a seis transplantes hepĂĄticos, realizados entre outubro de 2002 e setembro de 2004, com ĂłrgĂŁos obtidos de doadores em assistolia. RESULTADOS: NĂŁo houve disfunção primĂĄria do enxerto. ComplicaçÔes biliares e vasculares nĂŁo foram observadas. Todos os pacientes receberam alta hospitalar em boas condiçÔes clĂnicas. CONCLUSĂES: Embora se trate de uma experiĂȘncia pequena, bons resultados iniciais foram obtidos com transplante hepĂĄticos realizados a partir de doadores em assitolia