Transplante de fígado no Brasil: necessidade urgente de um novo sistema de aloca??o para as exce??es no escore MELD.

摘要

The Model for End-stage Liver Disease (MELD) was adoptedfor liver transplant allocation in USA in 2002, and in Brazil in 2006.The rational of this change was to prioritize the sicker patients,promote a better use of grafts, a less mortality in the waiting list,and a better allocation system with more equality and justice. Themodel was adopted worldwide due to its characteristics of beingsimple and a good predictor of mortality for patients with severechronic liver disease. However, there are some diseases in whichthe patients need to be transplanted but their score would neverreach a transplantable number. For this reason, many countriesproposed extra points for patients that do not fit the MELDformula – the “MELD exceptions”. The number of extra pointsand the criteria are not standardized in all countries and they aresomehow subjective(1).One example is the HCC patient. In mostcountries following a restrictive criteria (ex: Milan criteria) patientswith HCC receive extra points in MELD score in order to be transplantedin a time that minimize the chance of losing such criteriaor dying in the waiting list. The problem is the big difference interms of transplantable MELD score between the regionals insidethe country (states), the ABO blood types, the MELD exceptionsthemselves, and also the dynamic changes in the MELD requiredto be transplanted over time.