Increasing Survival Results in High MELD Recipients, What We Learn

Abstract

High MELD recipients are very usual cases in development countries, like Brazil, because of donor shortage and few transplant centers, most in Sao Paulo State and few or none in other States. Despite high MELD recipients, extended criteria donors are commonly used in a dangerous combination. Attitudes to improve survival are necessary to keep satisfactory survival results. Casuistic: Were analized 72 cases done in the last 14 months, after some providences to improve results. The most important were: donor selection, multi-professional training at international transplant centers (most in US and Europe), investment in hospital infra-structure and research at LIM 37 (Laboratory of Investigative Medicine). Patients with high MELD where considered when MELD Score was more or equal to 30. Results: The improve in survival curve detached of the Sao Paulo State curve (Figure 1), in a development country with the largest Public Transplant Program of the world, Sao Paulo has the largest Liver Program. Conclusion Providences like high investment in human resources and infra-structure and improve the experience of the transplant (donor/recipient) team as in basic research are keys to keep good results in development countries.