The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in S？o Paulo, Brazil

Until July 15, 2006, the time on the waiting list was the main criterion for allocating deceased donor livers in the state of S？o 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. 1. Introduction The global liver allocation system in use until 2002 was based on the Child-Turcotte-Pugh (CTP) scale and other scores as well as on the waiting time; the system became the major discriminator of patients on the waitlist without reflecting their actual liver dysfunction. The system for prioritising adult patients on the waitlist in the USA has since changed from a status-based algorithm using the CTP scale to a system using a continuous model for end-stage liver disease (MELD) [1]. The MELD score was originally developed to predict the survival after a transjugular intrahepatic portosystemic shunt procedure (TIPS) [2]. In S？o Paulo, the time on the waiting list was the primary criterion adopted to allocate deceased donor livers until July 15, 2006. After this date, MELD was the basis for the allocation of deceased donor livers for adult transplantation. The MELD score primarily sought to increase access to transplantation for severely ill patients as a means to reduce the mortality rate of the waiting list patients. The MELD score does not consider the posttransplant benefit. Our aim was to compare the waitlist dynamics in the pre-MELD (1997–2005) and post-MELD (2006–2012) periods in the state of S？o Paulo, Brazil. 2. Material and Methods A retrospective study was initially