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Results after the adoption of a MELD/PELD-based liver allocation policy in Argentina
Marcelo Dip1, Nora Cejas, Guillermo Cervio
1Sociedad Argentina de Trasplante, Ciudad Autonoma de Buenos Aires, Argentina; Instituto Nacional Central Unico Coordinador de Ablación e Implante (INCUCAI), Ciudad Autonoma de Buenos Aires, Argentina; Hospital de Pediatría Prof. Dr. JP Garrahan, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
Insights
Argentina
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Public Health Policy
Background:
- Argentina transitioned from a categorical liver allocation system to a Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease (MELD/PELD) policy in July 2005 for pediatric patients with chronic liver disease (CLD).
- This policy change aimed to optimize organ allocation and improve outcomes for children awaiting liver transplantation (LT).
Purpose of the Study:
- To analyze the impact of the MELD/PELD-based allocation system on waiting list (WL) outcomes and post-liver transplantation (LT) survival in children with CLD in Argentina.
Main Methods:
- A retrospective analysis of prospectively collected data from 923 children registered between January 2000 and December 2010.
- Comparison of two five-year periods: Era I (pre-MELD/PELD, January 2000-July 2005) and Era II (post-MELD/PELD, July 2005-December 2010).
- Statistical analysis using the Kaplan-Meier method to evaluate waiting list mortality and post-LT survival rates.
Main Results:
- Waiting list registrations increased by 44% and LT procedures by 24% after adopting the MELD/PELD system.
- A significant decrease in the three-month waiting list mortality rate was observed (32% to 18%, p < 0.0001).
- No significant differences were found in one-year post-LT survival (77.5% vs. 84.1%) or acute re-LT rates (9% vs. 5%) between the two eras.
Conclusions:
- The MELD/PELD-based system in Argentina significantly reduced waiting list mortality for children with CLD.
- This policy change did not negatively impact one-year post-LT survival or acute re-LT rates.
- Despite improved WL outcomes, a reduction in access to LT was noted under the new allocation system.
Abstract:
In July 2005, Argentina switched from a categorical liver allocation system to a MELD/PELD-based policy for patients with CLD. To analyze WL outcomes and survival after LT in children. From January 2000 to December 2010, 923 children were registered. Two consecutive five-yr periods were analyzed and compared: Era I (January 2000-July 2005) (n = 379) and Era II (July 2005-December 31, 2010) (n = 544). All data were prospectively collected and analyzed using the Kaplan-Meier method. After adopting the MELD/PELD system, WL registrations increased by 44% (from 379 to 544) and the number of LT increased by only 24% (from 278 to 365). However, three-month WL mortality rate (32% to 18%, p < 0.0001, HR 2.002 CI 95% 1.5-2.8) decreased significantly. No significant differences were observed between Era 1 and II in one-yr post-LT survival (77.5% vs. 84.1%, p = 0.3053) and in acute re-LT rate (9% vs. 5%, p = 0.1746). Under the MELD/PELD-based allocation system in Argentina, mortality on the WL significantly decreased in children with CLD without affecting post-LT survival, although reduced access to LT was observed.
