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 Liver Transplantation: Past Accomplishments and Future Challenges

1999 ◽  
Vol 13 (3) ◽  
pp. 257-263 ◽  
Author(s):  
William J Wall
Keyword(s):  
Liver Transplantation ◽  
Survival Rates ◽  
Alcoholic Cirrhosis ◽  
Liver Transplants ◽  
Recidivism Rates ◽  
Societal Challenges ◽  
Therapeutic Value ◽  
Future Challenges ◽  
Will Force ◽  
End Stage

Liver transplantation has evolved from a rare and risky operation of questionable therapeutic value to the preferred treatment for an extensive list of end-stage liver diseases. Superior immunosuppression (cyclosporine), and improvements in surgery and anesthesia brought liver grafting to its current level of success. Nearly 60,000 liver transplants have been performed, and survival rates are very good; however liver grafting faces serious immediate and long term challenges, mainly due to the widening gap between donor supply and recipient demand. Increasing numbers of sick candidates, recurrent disease (especially hepatitis C) and recidivism rates after transplantation for alcoholic cirrhosis will force increasingly difficult decisions on candidate selection and priority listing of potential recipients. Although xenotransplantation may be the ultimate solution, it has its own specific set of biological and societal challenges - the full extent of which should be revealed in the next several years.

scholarly journals Estimated prevalence of childhood end-stage renal disease in the state of São Paulo

2011 ◽  
Vol 57 (4) ◽  
pp. 436-441
Author(s):  
Paulo Cesar Koch Nogueira ◽  
Luciana de Santis Feltran ◽  
Maria Fernanda Camargo ◽  
Eliseth Ribeiro Leão ◽  
Jennifer R.C.S. Benninghoven ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Sao Paulo ◽  
The State ◽  
São Paulo ◽  
Stage Renal Disease ◽  
End Stage

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 Liver Transplantation in Patients with Acute-onChronic Liver Failure: Challenging the Limits

2021 ◽  
pp. 61-69
Author(s):  
Juan Manuel Diaz ◽  
Ezequiel Mauro ◽  
Maria Nelly Gutierrez-Acevedo ◽  
Adrian Gadano ◽  
Sebastian Marciano
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Causes Of Death ◽  
Meld Score ◽  
Organ Allocation ◽  
Short Term ◽  
Before And After ◽  
Short Term Mortality ◽  
End Stage

Acute-on-chronic liver failure (ACLF) is one of the main causes of death on the waiting list. Liver transplantation (LT) is the only curative treatment for patients with ACLF and therefore it should be considered in all cases. However, the applicability of LT in patients with ACLF is challenging, given the scarcity of donors and the high short-term mortality of these patients. Organ allocation has traditionally been prioritised according to the model for end-stage liver disease (MELD) system. However, the accuracy of MELD score is limited in patients with ACLF. In this article, the authors review the outcomes of patients with ACLF before and after LT, highlighting its clinical course, the feasibility of LT in the sickest patients, the role of the organ allocation system, and possible indicators of futility.

scholarly journals Prognosis of liver transplantation: Does postoperative ileus matter?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ruiping Bai ◽  
Rui An ◽  
Kunyu Han ◽  
Mengwen Xue ◽  
Simei Zhang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Survival Data ◽  
Postoperative Ileus ◽  
Total Bilirubin ◽  
Survival Rates ◽  
Major Complication ◽  
Meld Score ◽  
Gastrointestinal Dysfunction ◽  
End Stage ◽  
Relative Factors

Abstract Background Nowadays, liver transplantation has become a main therapy for end-stage liver disease. However, studies show that there are high mortality and severe complications after liver transplantation. Although gastrointestinal dysfunction is a common and major complication after liver transplantation, there was rarely relative research. This study aims to elucidate the factors about ileus after liver transplantation and patients’ survival. Methods We collected and analyzed the data (n = 318, 2016–2019) from the First Affiliated Hospital of Xi’an Jiaotong University. After excluding cases, a total of 293 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. We reviewed 38 variables (including preoperative, operative and postoperative relative factors). Additionally, other complications after liver transplantation and survival data were compared between two groups. Results Of the 293 patients, 23.2% (n = 68) experienced postoperative ileus. Ileus patients were not different with non-ileus patients in preoperative, operative and postoperative factors. HBV-positive patients with ileus had a lower MELD score (P = 0.025), and lower postoperative total bilirubin was correlated with ileus (P = 0.049). Besides, Child–Pugh score of HCC patients with ileus was low (P = 0.029). The complications after liver transplantation were not different between two groups. Compared with the patients without ileus, the patients with ileus had a higher mortality rate. Conclusion According to our research, ileus-patients had a lower 1-year survival rates. The preoperative MELD score and postoperative total bilirubin of HBV-positive patients with ileus were lower, and Child–Pugh score of HCC patients with ileus was also lower.

scholarly journals Modelling air temperature for the state of São Paulo, Brazil

2007 ◽  
Vol 64 (5) ◽  
pp. 460-467 ◽  
Author(s):  
Luis Rodríguez-Lado ◽  
Gerd Sparovek ◽  
Pablo Vidal-Torrado ◽  
Durval Dourado-Neto ◽  
Felipe Macías-Vázquez
Keyword(s):  
Regression Analysis ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Air Temperature ◽  
Sao Paulo ◽  
The State ◽  
Climatic Data ◽  
Regression Equations ◽  
São Paulo ◽  
Mean Values

Spatial modelling of air temperature (maximum, mean and minimum) of the State of São Paulo (Brazil) was calculated by multiple regression analysis and ordinary kriging. Climatic data (mean values of five or more years) were obtained from 256 meteorological stations distributed uniformly over the State. The correlation between the climatic dependent variables, with latitude and altitude as independent variables was significant and could explain most of the spatial variability. The coefficients of determination (P < 0.05) varied in the range of 0.924 and 0.953, showing that multiple regression analysis is an accurate method for the modelling of air temperature for the State of São Paulo. Finally, these regression equations were used together with the kriged maps of the residual errors to build 15 digital maps of air temperature using a 0.5 km² Digital Elevation Model in a Geographic Information System.

scholarly journals Modelling Kidney Outcomes Based On MELD Eras - Impact of MELD Score In Renal Endpoints After Liver Transplantation

2021 ◽  
Author(s):  
Paulo Ricardo Gessolo Lins ◽  
Roberto Camargo Narciso ◽  
Leonardo Rolim Ferraz ◽  
Virgilio Gonçalves Pereira ◽  
Ben-Hur Ferraz-Neto ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Mortality Rate ◽  
Kidney Injury ◽  
Meld Score ◽  
Solid Organ ◽  
Liver Transplants ◽  
Incidence And Mortality ◽  
Single Center Study ◽  
Allocation Criteria ◽  
Before And After

Abstract Background: Acute kidney injury is a common complication in solid organ transplants, notably liver transplantation. The MELD is a score validated to predict mortality of cirrhotic patients, which is also used for organ allocation, however the influence of this allocation criteria on AKI incidence and mortality after liver transplantation is still uncertain.Methods: This is a retrospective single center study of a cohort of patients submitted to liver transplant in a tertiary Brazilian hospital: Jan/2002 to Dec/2013, divided in two groups, before and after MELD implementation (pre MELD and post MELD). We evaluate the differences in AKI based on KDIGO stages and mortality rates between the two groups. Results: 874 patients were included, 408 in pre-MELD and 466 in the post MELD era. The proportion of patients that developed AKI was lower in the post MELD era (p 0.04), although renal replacement therapy requirement was more frequent in this group (p<0.01). Overall mortality rate at 28, 90 and 365 days was respectively 7%, 11% and 15%. The 1-year mortality rate was lower in the post MELD era (20% vs. 11%, p<0.01). AKI incidence was 50% lower in the post MELD era even when adjusted for clinically relevant covariates (p<0.01). Conclusion: Liver transplants performed in the post MELD era had a lower incidence of AKI, although there were more cases requiring dialysis. 1-year mortality was lower in the post MELD era, suggesting that patient care was improved during this period.

scholarly journals Prognosis of Liver Transplantation: Does Postoperative Ileus Matter ?

2020 ◽  
Author(s):  
Ruiping Bai ◽  
Rui An ◽  
Kunyu Han ◽  
Xin Shen ◽  
Zheng Shaohua
Keyword(s):  
Liver Transplantation ◽  
Survival Rate ◽  
Survival Data ◽  
Postoperative Ileus ◽  
Total Bilirubin ◽  
Survival Rates ◽  
Major Complication ◽  
Meld Score ◽  
End Stage ◽  
Relative Factors

Abstract Background: Nowadays, liver transplantation has become a main therapy for end-stage liver disease. However, studies show that there are high mortality and severe complications after liver transplantation. Although gastrointestinal dysfunction is a common and major complication among complications, there was rarely relative research. The study aims to elucidate the factors about ileus after liver transplantation and patients’ survival rate. Methods: We collected data (n=318, 2016–2019) from the First Affiliated Hospital of Xi’an Jiaotong University. After excluding cases, a total of 293 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. We reviewed 38 variables (including preoperative, operative and postoperative relative factors). In addition, other complications after liver transplantation and survival data were compared among groups. Results: Of the 293 patients, 23.2% (n=68) experienced postoperative ileus. Ileus patients were not different with non-ileus patients in preoperative, operative and postoperative factors. HBV-positive patients with ileus had a lower MELD score (P=0.025), and lower postoperative total bilirubin was correlated with ileus (P=0.049). Besides, Child-Pugh score of HCC patients with ileus was low (P=0.029). The complications after liver transplantation and survival rate were all not different among groups. Conclusions: According to our research, compared with non-ileus patients, we didn’t obtain the risk factors for patients with ileus. Ileus-patients didn’t increase complications after liver transplantation and didn’t decrease post-LT survival rates. But the preoperative MELD score and postoperative total bilirubin of HBV-positive patients with ileus were lower, and Child-Pugh score of HCC patients with ileus was also lower.

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