Serum sodium was incorporated to MELD score for the allocation of liver transplantation In the USA in 2016. Hyponatremia significantly increased the efficacy of the score to predict mortality on the waiting list. Such modification was not adopted in Brazil.
To carry out a simulation using MELD-Na as waiting list ordering criteria in the state of Paraná and to compare to the list ordered according to MELD score.
The study used data of 122 patients waiting for hepatic transplantation and listed at Parana´s Transplantation Central. Two classificatory lists were set up, one with MELD, the current qualifying criteria, and another with MELD-Na. We analyzed the changes on classification comparing these two lists.
Among all patients, 95.1% of the participants changed position, 30.3% showed improvement, 64.8% presented worsening and 4.9% maintained their position. There were 19 patients with hyponatremia, of whom 94.7% presented a change of position, and in all of them there was an improvement of position. One hundred and one patients presented sodium within the normal range and 95% of them presented a change of position: Improved placement was observed in 18.8%, and worsened placement in 76.2%. Two patients presented hypernatremia and changed their position, both worsening the placement. There was a significant different behavior on waiting list according to sodium serum level when MELD-Na was applied.
The inclusion of serum sodium caused a great impact in the classification, bringing benefit to patients with hyponatremia.
Tools such as MELD score and DRI are currently used to predict risks and benefits on liver allocation for transplantation.
To evaluate the relation between donor quality and recipient severity on liver allocation.
Liver transplants performed in 2017 and 2018 were evaluated. Data were collected from Paraná’s State Government Registry. DRI was evaluated in relation to recipient MELD score and position on waiting list.
It was observed relation between DRI and position on waiting list: higher risk organs were allocated to recipients with worse waiting list position. There was no relation between DRI and MELD score. Afrodescendents and elderly donor organs were allocated to lower MELD score and worse waiting list position recipients.
There is no relation between DRI and MELD on liver allocation. However, DRI interferes with allocation decision based on recipients waiting list position. Donor race and age interfere on both recipient MELD score and waiting list position
Desenvolvido por Surya MKT