O sistema MELD e a mortalidade em lista de espera para transplante de fígado em países em desenvolvimento: li？？es aprendidas em S？o Paulo

objective: the meld system has not yet been tested as an allocation tool for liver transplantation in the developing countries. in 2006, meld (model for end-stage liver disease) was launched as a new liver allocation system in s？o paulo, brazil. this study was designed to assess the results of the new allocation policy on waiting list mortality. methods: the state of s？o paulo liver transplant database was retrospectively reviewed from july 2003 through july 2009. patients were divided into those who were transplanted before (pre-meld group) and those who were transplanted after (post-meld group) the implementation of the meld system. only adult liver transplant candidates were included. waiting list mortality was the primary endpoint. results: the unadjusted death rate in waiting list decreased significantly after the implementation of the meld system (from 91.2 to 33.5/1,000 patients per year; p<0.0001). multivariate analysis showed a significant drop in risk of waiting list death for post-meld patients (hr 0.34; p<0.0001). currently, 48% of patients are transplanted within 1-year of listing (versus 23% in the pre-meld era; p<0.0001). patient and graft survival did not change with meld implementation. conclusion: there was a reduction in waiting time and list mortality after implementation of the meld system in s？o paulo. patients listed in the post-meld era had a significant reduction in risk for the waiting list mortality. there were no changes in post-transplant outcomes. meld can be successfully utilized for liver transplant allocation in developing countries.