MELD EXCEPTION POINTS PROVIDE AN ENOURMOUS ADVANTAGE FOR RECEIVING A LIVER TRANSPLANT IN BRAZIL

• Published in: Arquivos de gastroenterologia 2020-09, Vol.57 (3), p.254-261
• Main Authors: Arruda, Soraia, Chedid, Marcio F, Jacinto, Michelle Moraes, Álvares-DA-Silva, Mario R
• Format: Article
• Language: English
• Subjects: Brazil; Carcinoma, Hepatocellular - surgery; GASTROENTEROLOGY & HEPATOLOGY; Hepatic cirrhosis; Hepatocellular carcinoma; Humans; Liver diseases; Liver Neoplasms - surgery; Liver transplant; Liver Transplantation; Retrospective Studies; Severity of Illness Index; Waiting Lists
• ISSN: 0004-2803; 1678-4219; 1678-4219
• DOI: 10.1590/s0004-2803.202000000-48

Current policy for listing to liver transplant (LT) may place cirrhotic patients without MELD exception points (CIR) in a disadvantageous position if compared to patients enlisted with appealed MELD scores - patients with hepatocellular carcinoma (HCC) or special conditions other than hepatocellular carcinoma (SPE). Transplant rates, delisting, and waitlist mortality of CIR, HCC, and SPE candidates were compared. The aim of this study is to counterweight the listing rate and speed of listing of HCC, SPE, and CIR patients. To the best of our knowledge, this is the first study comparing the outcomes of patients enlisted for SPE to those of HCC and CIR. In several countries worldwide, SPE patients also receive appealed MELD scores in a similar way of HCC patients. Two cohorts of patients listed for LT in a single institution were evaluated. The first cohort (C1, n=180) included all patients enlisted on August 1st, 2008, and all additional patients listed from this date until July 31st, 2009. The second cohort (C2, n=109) included all patients present on the LT list on October 1st, 2012, and all additional patients listed from this date until May 2014. In both cohorts, HCC patients had a higher chance of receiving a LT than CIR patients (C1HR =2.05, 95%CI=1.54-2.72, P