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  • Title: Testing liver allocation in São Paulo, Brazil: the relationship of model for end-stage liver disease implementation with a reduction in waiting-list mortality.
    Author: Salvalaggio PR, Afonso RC, Pereira LA, Ferraz-Neto BH.
    Journal: Transplant Proc; 2012 Oct; 44(8):2283-5. PubMed ID: 23026574.
    Abstract:
    INTRODUCTION: In 2006, the model for end-stage liver disease (MELD) was launched as a new liver allocation system in Sao Paulo, Brazil. We designed this study to assess the results of the new allocation policy on waiting list mortality. METHODS: We reviewed the state of Sao Paulo liver transplant database from July 2003 through July 2009. Patients were divided in those who were transplanted before (pre-MELD group) and those who were transplanted after (post-MELD group) the implementation of the MELD system. Included were adult liver transplant candidates. Waiting list mortality was the primary endpoint. RESULTS: The unadjusted death rate in patients on the waiting list decreased significantly after the implementation of the MELD system (from 91.2 to 33.5/1000 patients/year, P < .0001). Multivariate analysis has shown a significant drop of the risk of waiting list death for post-MELD patients (odds ration 0.34, P < .0001). CONCLUSION: There was a reduction in waiting time and list mortality after the implementation of the MELD system in Brazil. Patients listed in the post-MELD era had a significant reduction of death risk on the waiting list. Future studies should assess posttransplant outcomes.
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