![]() Studies of the impact of the MELD on liver allocation and outcomes of liver transplantation included in the integrative review Eight answered the guiding question and were included in the final sample of the present review: four were from Pubmed, two from Lilacs and two from SciELO ( Figure 1). Using this tool, the 12 articles were selected and read in full. Articles with a score of six to ten were classified as being of good methodological quality and low bias (level A) 21 and were kept in the sample. These remaining selected articles were evaluated using a methodologically rigorous tool adapted from the Critical Appraisal Skills Programme (CAPS) 21 containing questions on the clarity of the objective, the adequacy of the methodology, theoretical and methodological procedures, sample selection, the relation between researcher and subject, ethical considerations, rigor and the foundation of data analysis, declaration of results, and the importance of the research.Įach item was worth one point and the score was the sum of points. Seven of the remaining articles were excluded for being duplicates, leaving 12 articles for analysis. A reading of available titles and abstracts led to the exclusion of 57 articles, 40 from Pubmed, eight from Lilacs and nine from SciELO. The initial search found 76 articles, 49 on Pubmed, 13 on Lilacs and 14 on SciELO. The selection criteria for articles stipulated that they be available in full, in English, Spanish or Portuguese and published between 20. ![]() The articles were searched for using headings controlled by the Virtual Health Library by way of the Health Sciences Headings "liver transplant," "survival analysis" and "end-stage liver disease", and the MESHs (Medical Subject Headings) "liver transplantation," "survival analysis" and "end-stage liver disease". The present study thus aims to examine the information produced on the MELD and its relation to survival and is guided by the following question: What impact does the MELD have on liver allocation and the results of liver transplants?Ī bibliographical survey was carried out in October 2015 using three indexed databases: Literatura Latino-Americana em Ciências da Saúde (Lilacs), the Scientific Eletronic Library Online (SciELO) and Pubmed. This change brought about a reduction of 3,5% in waiting list mortality, an increase of 10.2% in deceased donor transplants and a drop of 12% in patients scheduled for transplant 3,15.Įxamination of post-transplant survival showed that there may be a relation not defined by a high MELD score alone, but associated with the scarcity of organs, which led to the expansion of criteria for deceased donors beyond comorbidities. Since then, a policy has been adopted of using this procedure in more seriously ill patients, with the exception of emergencies and prioritized liver transplants, where allocation is conducted using other criteria, in accordance with current legislation 1, 4, 15, 27. The MELD as indicator of the severity of the clinical status of the recipient was introduced as a criterion in Brazil in 2006 by Decree 1160. It is thus possible to obtain a good predictor of mortality, with a score close to 40 indicating minimal likelihood of survival within three months 1, 5, 8. In 2002, the United States started using this score as a criterion for liver allocation 13, 26.Ī logarithmic calculation involving serum creatinine, bilirubin and International Normalized Ratio is used to obtain the MELD score for recipients aged over 12 years. However, it was noted that mortality on the waiting list was not related only to the waiting time 3, 10.ĭescribed for the first time in 2000, the aim of the MELD (Model for End-stage Liver Disease) score was to predict the three-month survival rate in patients who underwent a transjugular intrahepatic portosystemic anastomosis 1, 3, 8.Ī 2001, study validated the MELD score as a measure of the probability of mortality within three months in transplant patients with end-stage chronic liver disease. At this time, the criterion used for conducting a transplant was time. In 1997, the National Organ Transplant and Notification and Distribution Centers System was set up, which enabled the introduction of a Single Technical Register and a single waiting list 1. The organ and tissue allocation system in Brazil has been through various phases that have led to better organization and greater credibility, reducing waiting lists and hence mortality 1. Since the first transplant, in 1963, many changes have significantly improved its success rate 18. ![]() The aim of a liver transplant is to increase the survival of a patient with end-stage liver disease and to improve quality of life 15. ![]()
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