Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil
Autor(a) principal: | |
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Data de Publicação: | 2011 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Clinics |
Texto Completo: | https://www.revistas.usp.br/clinics/article/view/19453 |
Resumo: | 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. |
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Clinics |
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Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil Organ transplantationSurvival analysisMortalityGovernment regulationLiver grafts 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. Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo2011-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/clinics/article/view/1945310.1590/S1807-59322011000100011Clinics; Vol. 66 No. 1 (2011); 57-64 Clinics; v. 66 n. 1 (2011); 57-64 Clinics; Vol. 66 Núm. 1 (2011); 57-64 1980-53221807-5932reponame:Clinicsinstname:Universidade de São Paulo (USP)instacron:USPenghttps://www.revistas.usp.br/clinics/article/view/19453/21516Batista, Thales PauloSabat, Bernardo DavidMelo, Paulo Sérgio V.Miranda, Luiz Eduardo C.Fonseca-Neto, Olival Cirilo L.Amorim, Américo GusmãoLacerda, Cláudio Mourainfo:eu-repo/semantics/openAccess2012-05-23T16:41:39Zoai:revistas.usp.br:article/19453Revistahttps://www.revistas.usp.br/clinicsPUBhttps://www.revistas.usp.br/clinics/oai||clinics@hc.fm.usp.br1980-53221807-5932opendoar:2012-05-23T16:41:39Clinics - Universidade de São Paulo (USP)false |
dc.title.none.fl_str_mv |
Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil |
title |
Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil |
spellingShingle |
Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil Batista, Thales Paulo Organ transplantation Survival analysis Mortality Government regulation Liver grafts |
title_short |
Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil |
title_full |
Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil |
title_fullStr |
Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil |
title_full_unstemmed |
Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil |
title_sort |
Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil |
author |
Batista, Thales Paulo |
author_facet |
Batista, Thales Paulo Sabat, Bernardo David Melo, Paulo Sérgio V. Miranda, Luiz Eduardo C. Fonseca-Neto, Olival Cirilo L. Amorim, Américo Gusmão Lacerda, Cláudio Moura |
author_role |
author |
author2 |
Sabat, Bernardo David Melo, Paulo Sérgio V. Miranda, Luiz Eduardo C. Fonseca-Neto, Olival Cirilo L. Amorim, Américo Gusmão Lacerda, Cláudio Moura |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Batista, Thales Paulo Sabat, Bernardo David Melo, Paulo Sérgio V. Miranda, Luiz Eduardo C. Fonseca-Neto, Olival Cirilo L. Amorim, Américo Gusmão Lacerda, Cláudio Moura |
dc.subject.por.fl_str_mv |
Organ transplantation Survival analysis Mortality Government regulation Liver grafts |
topic |
Organ transplantation Survival analysis Mortality Government regulation Liver grafts |
description |
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. |
publishDate |
2011 |
dc.date.none.fl_str_mv |
2011-01-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/clinics/article/view/19453 10.1590/S1807-59322011000100011 |
url |
https://www.revistas.usp.br/clinics/article/view/19453 |
identifier_str_mv |
10.1590/S1807-59322011000100011 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/clinics/article/view/19453/21516 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo |
publisher.none.fl_str_mv |
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo |
dc.source.none.fl_str_mv |
Clinics; Vol. 66 No. 1 (2011); 57-64 Clinics; v. 66 n. 1 (2011); 57-64 Clinics; Vol. 66 Núm. 1 (2011); 57-64 1980-5322 1807-5932 reponame:Clinics instname:Universidade de São Paulo (USP) instacron:USP |
instname_str |
Universidade de São Paulo (USP) |
instacron_str |
USP |
institution |
USP |
reponame_str |
Clinics |
collection |
Clinics |
repository.name.fl_str_mv |
Clinics - Universidade de São Paulo (USP) |
repository.mail.fl_str_mv |
||clinics@hc.fm.usp.br |
_version_ |
1800222757292605440 |