Análisis del sistema de alistamiento y priorización para trasplante hepático de adultos en Chile
Background: In Chile, organ allocation for liver transplantation (LT) in adults is prioritized according to the MELD-Na score. Exceptions such as Hepatocellular Carcinoma (HCC) and other non-HCC exceptions receive a score called Operational MELD score. Aim: To evaluate the effectiveness of the MEL...
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| Lenguaje: | Spanish / Castilian |
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Sociedad Médica de Santiago
2020
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oai:scielo:S0034-988720200011015412021-04-04Análisis del sistema de alistamiento y priorización para trasplante hepático de adultos en ChileWolff,RodrigoDíaz,Luis AntonioNorero,BlancaUrzúa,ÁlvaroMezzano,GabrielHumeres,RobertoInnocenti,FrancoCastro,LorenaPavez,ClaudiaDerosas,CarlosElgueta,Susana Carcinoma Hepatocellular Waiting Lists Liver Transplantation Tissue and Organ Procurement Background: In Chile, organ allocation for liver transplantation (LT) in adults is prioritized according to the MELD-Na score. Exceptions such as Hepatocellular Carcinoma (HCC) and other non-HCC exceptions receive a score called Operational MELD score. Aim: To evaluate the effectiveness of the MELD-Na score and the operational MELD score as a prioritization system for LT in Chile. Material and Methods: Retrospective analysis of the waiting list (WL) of adult candidates (≥ 15 years) for elective LT in Chile from 2011 to 2017. The probability of leaving the WL, defined by death or contraindication for LT was compared in three groups: 1) Cirrhotic patients prioritized according to their real MELD-Na score (CPM), 2) HCC and 3) other non-HCC exceptions. Results: We analyzed 730 candidates for LT, with a median age of 57 years, 431 (56%) were men. In the study period, 352 LT were performed (48%). The annual exit rate was significantly higher in the CPM group (45.5%) compared to HCC (33.1%) and non-HCC (29.3%), (p < 0.001). Post LT survival was 86% at 1 year and 85% at 5 years, without significant differences between groups. In the CPM group, post-transplant survival was significantly lower (p < 0.05) in patients with MELD-Na ≥ 30 at transplant (81% per year) compared to patients with patients with MELD-Na < 30 (91% per year). Conclusions: MELD-Na score can discriminate very well patients who have a higher risk of death in the short and medium term. However, the assignment of operational scores for situations of exception produces inequities in the allocation of organs for LT and must therefore be carefully adjusted.info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.148 n.11 20202020-11-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872020001101541es10.4067/S0034-98872020001101541 |
| institution |
Scielo Chile |
| collection |
Scielo Chile |
| language |
Spanish / Castilian |
| topic |
Carcinoma Hepatocellular Waiting Lists Liver Transplantation Tissue and Organ Procurement |
| spellingShingle |
Carcinoma Hepatocellular Waiting Lists Liver Transplantation Tissue and Organ Procurement Wolff,Rodrigo Díaz,Luis Antonio Norero,Blanca Urzúa,Álvaro Mezzano,Gabriel Humeres,Roberto Innocenti,Franco Castro,Lorena Pavez,Claudia Derosas,Carlos Elgueta,Susana Análisis del sistema de alistamiento y priorización para trasplante hepático de adultos en Chile |
| description |
Background: In Chile, organ allocation for liver transplantation (LT) in adults is prioritized according to the MELD-Na score. Exceptions such as Hepatocellular Carcinoma (HCC) and other non-HCC exceptions receive a score called Operational MELD score. Aim: To evaluate the effectiveness of the MELD-Na score and the operational MELD score as a prioritization system for LT in Chile. Material and Methods: Retrospective analysis of the waiting list (WL) of adult candidates (≥ 15 years) for elective LT in Chile from 2011 to 2017. The probability of leaving the WL, defined by death or contraindication for LT was compared in three groups: 1) Cirrhotic patients prioritized according to their real MELD-Na score (CPM), 2) HCC and 3) other non-HCC exceptions. Results: We analyzed 730 candidates for LT, with a median age of 57 years, 431 (56%) were men. In the study period, 352 LT were performed (48%). The annual exit rate was significantly higher in the CPM group (45.5%) compared to HCC (33.1%) and non-HCC (29.3%), (p < 0.001). Post LT survival was 86% at 1 year and 85% at 5 years, without significant differences between groups. In the CPM group, post-transplant survival was significantly lower (p < 0.05) in patients with MELD-Na ≥ 30 at transplant (81% per year) compared to patients with patients with MELD-Na < 30 (91% per year). Conclusions: MELD-Na score can discriminate very well patients who have a higher risk of death in the short and medium term. However, the assignment of operational scores for situations of exception produces inequities in the allocation of organs for LT and must therefore be carefully adjusted. |
| author |
Wolff,Rodrigo Díaz,Luis Antonio Norero,Blanca Urzúa,Álvaro Mezzano,Gabriel Humeres,Roberto Innocenti,Franco Castro,Lorena Pavez,Claudia Derosas,Carlos Elgueta,Susana |
| author_facet |
Wolff,Rodrigo Díaz,Luis Antonio Norero,Blanca Urzúa,Álvaro Mezzano,Gabriel Humeres,Roberto Innocenti,Franco Castro,Lorena Pavez,Claudia Derosas,Carlos Elgueta,Susana |
| author_sort |
Wolff,Rodrigo |
| title |
Análisis del sistema de alistamiento y priorización para trasplante hepático de adultos en Chile |
| title_short |
Análisis del sistema de alistamiento y priorización para trasplante hepático de adultos en Chile |
| title_full |
Análisis del sistema de alistamiento y priorización para trasplante hepático de adultos en Chile |
| title_fullStr |
Análisis del sistema de alistamiento y priorización para trasplante hepático de adultos en Chile |
| title_full_unstemmed |
Análisis del sistema de alistamiento y priorización para trasplante hepático de adultos en Chile |
| title_sort |
análisis del sistema de alistamiento y priorización para trasplante hepático de adultos en chile |
| publisher |
Sociedad Médica de Santiago |
| publishDate |
2020 |
| url |
http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872020001101541 |
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