Model for end-stage liver disease-based allocation system for liver transplantation in Argentina: does it work outside the United States?

AbstractBackgroundIn July 2005, Argentina was the first country after the United States to adopt the MELD system. The purpose of the present study was to analyse the impact of this new system on the adult liver waiting list (WL).MethodsBetween 2005 and 2009, 1773 adult patients were listed for liver transplantation: 150 emergencies and 1623 electives. Elective patients were categorized using the MELD system. A prospective database was used to analyse mortality and probability to be transplanted (PTBT) on the WL.ResultsThe waiting time increased inversely with the MELD score and PTBT positively correlated with MELD score. With scores≥18 the PTBT remained over 50%. However, the largest MELD subgroup with <10 points (n=433) had the lower PTBT (3%). In contrast, patients with T2 hepatocellular carcinoma benefited excessively with the highest PTBT (84.2%) and the lowest mortality rate (5.4%). The WL mortality increased after MELD adoption (10% vs. 14.8% vs. P<0.01). Patients with <10 MELD points had >fourfold probability of dying on the WL than PTBT (14.3% vs. 3%; P<0.0001).ConclusionsAfter MELD implementation, WL mortality increased and most patients who died had a low MELD score. A comprehensive revision of the MELD system must be performed to include cultural and socio-economical variables that could affect each country individually

Short- and Long-Term Outcomes of Every Graft Recovered During a Multi-Organ Procurement Procedure Including the Intestine

Background: The development of intestinal transplant (Tx) programs introduces thymoglobulin donor treatment as well as an almost complete warm dissection of the abdominal organs to allocate them to different recipients. Our aim is to assess the reproducibility and feasibility of the surgical technique of multi-organ procurement with the use of thymoglobulin donor pre-treatment and report the short- and long-term outcomes of every graft harvested as part of multi-organ procurement (MTOp), including the intestine.MethodsData were collected of all organs harvested from MTOp, including the intestines allocated to our center from March 2006 to July 2011. Data from 92 recipients and 116 organs procured from 29 MTOp were analyzed. Twelve hearts, 2 lungs, and 1 cardio-pulmonary block were transplanted; primary graft dysfunction developed in 4 of the 12 hearts and in the cardio-pulmonary block.ResultsThe survival rate was 75% and 100% for hearts and lungs, respectively. Nineteen livers, 9 kidney-pancreas, 19 kidneys, and 29 intestines were transplanted. Delayed graft function (DGF) of the pancreas developed in 3 of 9 kidney-pancreas, and the other 3 exhibited DGF of the kidney; 4 of 19 Tx kidneys had DGF. The survival was 84%, 78%, 95%, and 65.5% for livers, kidney-pancreas, kidneys, and intestines, respectively.ConclusionsOrgans procured during MTOp including the intestine can be safely used, increasing organ availability and transplant applicability without compromising allocation, quality, and long-term results of the non-intestinal?procured organs.Fil: Farinelli, P. A.. Universidad Favaloro. Área de Investigación y Desarrollo; ArgentinaFil: Padin, J. M.. Universidad Favaloro; Argentina. Universidad Favaloro. Área de Investigación y Desarrollo; ArgentinaFil: Troncoso J. Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI); ArgentinaFil: Bertolotti, A.. Universidad Favaloro. Área de Investigación y Desarrollo; ArgentinaFil: Lenz, M.. Hospital Italiano; ArgentinaFil: Sanchez, N.. Instituto de Nefrología de Buenos Aires; ArgentinaFil: Fortunato, R.. Universidad Favaloro. Área de Investigación y Desarrollo; ArgentinaFil: Caravello, E.. Hospital Italiano; ArgentinaFil: Imperiali, N.. Hospital Italiano; ArgentinaFil: Dip, M.. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Sanchez Claria, R. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Arriola, M.. Clínica de Nefrología, Urología y Enfermedades Cardiovasculares de la Ciudad de Santa Fe; ArgentinaFil: De Arteaga. J. Hospital Privado de Córdoba; ArgentinaFil: Pujol Soler, G.. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Bisigniano, L.. Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI); ArgentinaFil: Gil, O. Sanatorio Allende; ArgentinaFil: McCormack, L.. Hospital Aleman; ArgentinaFil: Botta, E.. Clínica de Nefrología, Urología y Enfermedades Cardiovasculares de la Ciudad de Santa Fe; ArgentinaFil: Inventarza, O.. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; ArgentinaFil: Gaite, L.. Clínica de Nefrología, Urología y Enfermedades Cardiovasculares de la Ciudad de Santa Fe; ArgentinaFil: Hyon, Sung Ho. Hospital Italiano; ArgentinaFil: Raffaele, P.. Universidad Favaloro. Área de Investigación y Desarrollo; ArgentinaFil: Illanes, G. Clínica de Nefrología, Urología y Enfermedades Cardiovasculares de la Ciudad de Santa Fe; ArgentinaFil: de Santibañez, E.. Hospital Italiano; ArgentinaFil: Favaloro R. Universidad Favaloro. Área de Investigación y Desarrollo; ArgentinaFil: Gondolesi, Gabriel Eduardo. Universidad Favaloro. Área de Investigación y Desarrollo; Argentin