Prioritization for liver transplantation using the MELD score in Chile: Inequities generated by MELD exceptions.: A collaboration between the Chilean Liver Transplant Programs, the Public Health Institute and the National Transplant Coordinator

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dc.contributor.authorDíaz, Luis
dc.contributor.authorNorero, Blanca
dc.contributor.authorLara, Bárbara
dc.contributor.authorRobles, Camila
dc.contributor.authorElgueta, Susana
dc.contributor.authorHumeres, Roberto
dc.contributor.authorPoniachik, Jaime
dc.contributor.authorSilva, Guillermo
dc.contributor.authorWolff, Rodrigo
dc.contributor.authorInnocenti, Franco
dc.contributor.authorRojas, José
dc.contributor.authorZapata, Rodrigo
dc.contributor.authorHunter, Bessie
dc.contributor.authorÁlvarez, Sergio
dc.contributor.authorCancino, Alejandra
dc.contributor.authorIbarra, José
dc.contributor.authorRius, Montserrat
dc.contributor.authorGonzález, Sandra
dc.contributor.authorCalabrán, Lorena
dc.contributor.authorPérez, Rosa
dc.date.accessioned2022-07-06T16:43:29Z
dc.date.available2022-07-06T16:43:29Z
dc.date.issued2019
dc.description.abstractIntroduction 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.es
dc.description.versionVersión publicadaes
dc.identifier.citationDíaz LA, Norero B, Lara B, Robles C, Elgueta S, Humeres R, Poniachik J, Silva G, Wolff R, Innocenti F, Rojas JL, Zapata R, Hunter B, Álvarez S, Cancino A, Ibarra J, Rius M, González S, Calabrán L, Pérez RM. Prioritization for liver transplantation using the MELD score in Chile: Inequities generated by MELD exceptions.: A collaboration between the Chilean Liver Transplant Programs, the Public Health Institute and the National Transplant Coordinator. Ann Hepatol. 2019 Mar-Apr;18(2):325-330. doi: 10.1016/j.aohep.2018.11.001es
dc.identifier.urihttps://doi.org/10.1016/j.aohep.2018.11.001es
dc.identifier.urihttp://hdl.handle.net/11447/6309
dc.language.isoenes
dc.subjectCadaveric liver transplantationes
dc.subjectChronic liver diseasees
dc.subjectLiver transplantationes
dc.subjectWaitlist mortalityes
dc.titlePrioritization for liver transplantation using the MELD score in Chile: Inequities generated by MELD exceptions.: A collaboration between the Chilean Liver Transplant Programs, the Public Health Institute and the National Transplant Coordinatores
dc.typeArticlees
dcterms.sourceAnnals of Hepatologyes

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