scholarly journals The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo, Brazil

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Eleazar Chaib ◽  
Eduardo Massad ◽  
Bruno Butturi Varone ◽  
Andre Leopoldino Bordini ◽  
Flavio Henrique Ferreira Galvão ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Deceased Donor ◽  
Sao Paulo ◽  
Meld Score ◽  
Waiting List ◽  
São Paulo ◽  
Clear Trend ◽  
Number Of Patients ◽  
Liver Transplantations ◽  
The Impact

Until July 15, 2006, the time on the waiting list was the main criterion for allocating deceased donor livers in the state of São Paulo, Brazil. After this date, MELD has been the basis for the allocation of deceased donor livers for adult transplantation. Our aim was to compare the waitlist dynamics before MELD (1997–2005) and after MELD (2006–2012) in our state. A retrospective study was conducted including the data from all the liver transplant candidate waiting lists from July 1997 to December 2012. The data were related to the actual number of liver transplantations (Tr), the incidence of new patients on the list (I), and the number of patients who died while being on the waitlist (D) from 1997 to 2005 (the pre-MELD era) and from 2006 to 2012 (the post-MELD era). The number of transplantations from 1997 to 2005 and from 2006 to 2012 increased nonlinearly, with a clear trend to levelling to equilibrium at approximately 350 and 500 cases per year, respectively. The implementation of the MELD score resulted in a shorter waiting time until liver transplantation. Additionally, there was a significant effect on the waitlist dynamics in the first 4 years; however, the curves diverge from there, implying a null long-range effect on the waitlist by the MELD scores.

scholarly journals Critical analysis of the allocation policy for liver transplantation in Brazil

2003 ◽  
Vol 58 (3) ◽  
pp. 179-184 ◽  
Author(s):  
Hoel Sette Jr. ◽  
Telesforo Bacchella ◽  
Marcel Cerqueira César Machado
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Distributive Justice ◽  
Waiting Time ◽  
Sao Paulo ◽  
Waiting List ◽  
Third Party ◽  
São Paulo ◽  
Donor Pool ◽  
Number Of Patients

Liver transplantation is now the standard treatment for end-stage liver disease. Given the shortage of liver donors and the progressively higher number of patients waiting for transplantation, improvements in patient selection and optimization of timing for transplantation are needed. Several solutions have been suggested, including increasing the donor pool; a fair policy for allocation, not permitting variables such as age, gender, and race, or third-party payer status to play any role; and knowledge of the natural history of each liver disease for which transplantation is offered. To observe ethical rules and distributive justice (guarantee to every citizen the same opportunity to get an organ), the "sickest first" policy must be used. Studies have demonstrated that death has no relationship with waiting time, but rather with the severity of liver disease at the time of inclusion. Thus, waiting time is no longer part of the United Network for Organ Sharing distribution criteria. Waiting time only differentiates between equally severely diseased patients. The authors have analyzed the waiting list mortality and 1-year survival for patients of the State of São Paulo, from July 1997 through January 2001. Only the chronological criterion was used. According to "Secretaria de Estado da Saúde de São Paulo" data, among all waiting list deaths, 82.2% occurred within the first year, and 37.6% within the first 3 months following inclusion. The allocation of livers based on waiting time is neither fair nor ethical, impairs distributive justice and human rights, and does not occur in any other part of the world.

scholarly journals Adoption of MELD score increases the number of liver transplant

2014 ◽  
Vol 27 (3) ◽  
pp. 201-203 ◽  
Author(s):  
Lucas Souto NACIF ◽  
Wellington ANDRAUS ◽  
Rodrigo Bronze MARTINO ◽  
Vinicius Rocha SANTOS ◽  
Rafael Soares PINHEIRO ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Survival Rates ◽  
Sao Paulo ◽  
Meld Score ◽  
The State ◽  
São Paulo ◽  
Liver Transplants ◽  
Mean Values ◽  
Before And After ◽  
End Stage

BACKGROUND: Liver transplantation is performed at large transplant centers worldwide as a therapeutic intervention for patients with end-stage liver diseases. AIM: To analyze the outcomes and incidence of liver transplantation performed at the University of São Paulo and to compare those with the State of São Paulo before and after adoption of the Model for End-Stage Liver Disease (MELD) score. METHOD: Evaluation of the number of liver transplantations before and after adoption of the MELD score. Mean values and standard deviations were used to analyze normally distributed variables. The incidence results were compared with those of the State of São Paulo. RESULTS: There was a high prevalence of male patients, with a predominance of middle-aged. The main indication for liver transplantation was hepatitis C cirrhosis. The mean and median survival rates and overall survival over ten and five years were similar between the groups (p>0.05). The MELD score increased over the course of the study period for patients who underwent liver transplantation (p>0.05). There were an increased number of liver transplants after adoption of the MELD score at this institution and in the State of São Paulo (p<0.001). CONCLUSION: The adoption of the MELD score led to increase the number of liver transplants performed in São Paulo.

scholarly journals EVALUATION AND SELECTION OF CANDIDATES FOR LIVER TRANSPLANTATION: AN ECONOMIC PERSPECTIVE

2020 ◽  
Vol 57 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Santiago RODRÍGUEZ ◽  
Fabio Da MOTTA ◽  
Giacomo BALBINOTO NETO ◽  
Ajacio BRANDÃO
Keyword(s):  
Liver Transplantation ◽  
Care Center ◽  
Tertiary Care ◽  
Deceased Donor ◽  
Waiting List ◽  
Transplant Center ◽  
Number Of Patients ◽  
Common Problems ◽  
Selection Of

ABSTRACT BACKGROUND: Over the next 20 years, the number of patients on the waiting list for liver transplantation (LTx) is expected to increase by 23%, while pre-LTx costs should raise by 83%. OBJECTIVE: To evaluate direct medical costs of the pre-LTx period from the perspective of a tertiary care center. METHODS: The study included 104 adult patients wait-listed for deceased donor LTx between October 2012 and May 2016 whose treatment was fully provided at the study transplant center. Clinical and economic data were obtained from electronic medical records and from a hospital management software. Outcomes of interest and costs of patients on the waiting list were compared through the Kruskal-Wallis test. A generalized linear model with logit link function was used for multivariate analysis. P-values <0.05 were considered statistically significant. RESULTS: The costs of patients who underwent LTx ($8,879.83; 95% CI 6,735.24-11,707.27; P<0.001) or who died while waiting ($6,464.73; 95% CI 3,845.75-10,867.28; P=0.04) were higher than those of patients who were excluded from the list for any reason except death ($4,647.78; 95% CI 2,469.35-8,748.04; P=0.254) or those who remained on the waiting list at the end of follow-up. CONCLUSION: Although protocols of inclusion on the waiting list vary among transplant centers, similar approaches exist and common problems should be addressed. The results of this study may help centers with similar socioeconomic realities adjust their transplant policies.

Impacto de causas de morte na esperança de vida em São Paulo, 2000 e 2010

2019 ◽  
Vol 9 ◽  
pp. 244
Author(s):  
Fernando Flores Santos Ribeiro ◽  
Eliane Menezes Flores Santos ◽  
André Renê Barboni
Keyword(s):  
Life Expectancy ◽  
Causes Of Death ◽  
Sao Paulo ◽  
Capital City ◽  
São Paulo ◽  
Clear Trend ◽  
Life Expectancy At Birth ◽  
Life Years ◽  
The Difference ◽  
The Impact

Foi levantado e analisado o impacto de algumas causas de morte na esperança de vida (EV) dos residentes dos bairros centrais e periféricos de São Paulo (capital), 2000 e 2010. Analisou-se a importância dos grupos de causas de óbito na EV, utilizando-se tábuas de vida e a teoria de riscos competitivos. os cinco capítulos da CiD10 analisados abrangem mais de três quartos dos óbitos, em ambos os sexos, nos anos estudados. Nota-se uma clara tendência de envelhecimento de ambas as regiões. A diferença da Esperança de Vida ao Nascer (EVN) entre mulheres e homens do centro e da periferia diminuiu, mas a disparidade entre áreas aumentou. A análise dos Anos Potenciais de Vida Ganhos, através da eliminação do risco de morrer por alguns grupos de causa de morte, mostra diferenças em função da importância relativa que cada grupo tem em cada uma das populações e permite ao gestor estabelecer uma política mais específica e resolutiva que certamente irá se refletir na qualidade de vida. Fica claro que existem duas realidades muito diferentes dentro do mesmo município. Provavelmente isso também é válido para o restante do Brasil.AbstractThe study analyzed the impact of some causes of death in the life expectancy of the central and peripheral districts residents of São Paulo (capital city), 2000 and 2010. the importance of the groups of causes of death was measured by life tables and the theory of competitive risks. The five chapters of ICD10 analyzed cover more than three quarters of deaths in both sexes. there was a clear trend towards aging in both regions. The difference in Life Expectancy at Birth between women and men in the center and the periphery decreased, but the disparity between areas increased. the analysis of the Potential Life Years Earnings by eliminating the risk of dying by some cause of death groups shows differences depending on the relative importance that each group has in each of the populations and allows the manager to establish a more specific policy, which will certainly be reflected in the quality of life. It is clear that there are two very different realities within the same city. This is probably also true for the rest of Brazil

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