Increasing Survival Results in High MELD Recipients, What We Learned
Andre I David, MD, PhD1, Allison Trevizol, Acad2, Rafael AA Pecora, MD1, Eduardo T Yamashita,
Acad2, Rafael SN Pinheiro, MD1, Ruy JC Junior, MD, PhD1 , Luiz Augusto C D'Albuquerque, MD, PhD1.
1- Gastroenterology/Transplant - LIM 37, Faculdade de Medicina da Universidade de Sao Paulo,
2- Surgery, Santa Casa Medical School, Sao Paulo, Brazil.
Introduction
High MELD recipients are very usual cases in development countries, like Brazil, because of donor
shortage and few transplant centers, most in Sao Paulo State and few or none in other States.
Despite high MELD recipients, extended criteria donors are commonly used in a dangerous
combination. Attitudes to improve survival are necessary to keep satisfactory survival results.
Casuistic
Were analyzed 72 cases done in the last 14 months, after some providences to improve results. The
most important were: donor selection, multi-professional training at international transplant centers
(most in US and Europe), investment in hospital infra-structure and research at LIM 37 (Laboratory of
Figure 1
Investigative Medicine).
Patients with high MELD where considered when MELD Score was more or equal to 30.
Results
The improve in survival curve detached of the Sao Paulo State curve (figure 1), in a development
country with the largest Public Transplant Program of the world, Sao Paulo has the largest Liver
Program.
The high MELD patients had similar results of that with MELD > 30 in the last 14 months. (figure 2).
Conclusion
Providences like high investment in human resources, infra-structure and improve the experience of
the transplant (donor/recipient) team as in basic research are keys to keep good results in
development countries.
References
1. SRTR website, http://srtr.transplant.hrsa.gov/annual_reports/2011/pdf/03_%20liver_12.pdf.
2. Registro Brasileiro de Transplante [internet database ]. 2013. Available from:
http://www.abto.org.br/abtov03/Upload/file/RBT/2012/RBT-dimensionamento2012.pdf
3. Ravaioli M, Grazi GL, Ercolani G, et al. The future challenge in the MELD era: how to match extended-use donors and
Printed by
sick recipients. Transplantation. 2006;7:987
4. Kamath PS, Kim WR. The Model for End-Stage Liver Disease. 2007;45(3):797-850.
Figure 2