Annals of Hepatology (Mar 2019)

Prioritization for liver transplantation using the MELD score in Chile: Inequities generated by MELD exceptions.

  • Luis A. Díaz,
  • Blanca Norero,
  • Bárbara Lara,
  • Camila Robles,
  • Susana Elgueta,
  • Roberto Humeres,
  • Jaime Poniachik,
  • Guillermo Silva,
  • Rodrigo Wolff,
  • Franco Innocenti,
  • José L. Rojas,
  • Rodrigo Zapata,
  • Bessie Hunter,
  • Sergio Álvarez,
  • Alejandra Cancino,
  • José Ibarra,
  • Montserrat Rius,
  • Sandra González,
  • Lorena Calabrán,
  • Rosa M. Pérez

Journal volume & issue
Vol. 18, no. 2
pp. 325 – 330

Abstract

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Introduction and aim: The MELD score has been established as an efficient and rigorous prioritization system for liver transplant (LT). Our study aimed to evaluate the effectiveness of the MELD score as a system for prioritization for LT, in terms of decreasing the dropout rate in the waiting list and maintaining an adequate survival post-LT in Chile. Materials and methods: We analyzed the Chilean Public Health Institute liver transplant registry of candidates listed from October 15th 2011 to December 31st 2014. We included adult candidates (>15 years old) listed for elective cadaveric LT with a MELD score of 15 or higher. Statistical analysis included survival curves (Kaplan–Meier), log-rank statistics and multivariate logistic regression. Results: 420 candidates were analyzed. Mean age was 53.6 ± 11.8 years, and 244 were men (58%). Causes of LT included: Liver cirrhosis without exceptions (HC) 177 (66.4%); hepatocellular carcinoma (HCC) 111 (26.4%); cirrhosis with non-HCC exceptions 102 (24.3%) and non-cirrhotic candidates 30 (7.2%). LT rate was 43.2%. The dropout rate was 37.6% at 1-year. Even though the LT rate was higher, the annual dropout rate was significantly higher in cirrhotic candidates (without exceptions) compared with cirrhotics with HCC, and non-HCC exceptions plus non-cirrhotic candidates (47.9%; 37.2% and 24.2%, respectively, with p = 0.004). Post-LT survival was 84% per year, with no significant differences between the three groups (p = 0.95). Conclusion: Prioritization for LT using the MELD score system has not decreased the dropout rate in Chile (persistent low donor's rate). Exceptions generate inequities in dropout rate, disadvantaging patients without exceptions.

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