Access to Liver Transplantation in Different ABO-Blood Groups and “Exceptions Points” in a Model for End-Stage Liver Disease Allocation System: A Brazilian Single-Center Study

In the Model for End-Stage Liver Disease (MELD) system, patients with “MELD exceptions” points may have unfair privilege in the competition for liver grafts. Furthermore, organ distribution following identical ABO blood types may also result in unjust organ allocation. The aim of this study was to i...

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Bibliographic Details
Published in:	Transplantation proceedings 2018-04, Vol.50 (3), p.754-757
Main Authors:	Martino, R.B., Waisberg, D.R., Dias, A.P.M., Inoue, V.B.S., Arantes, R.M., Haddad, L.B.P., Rocha-Santos, V., Pinheiro, R.S.N., Nacif, L.S., D'Albuquerque, L.A.C.
Format:	Article
Language:	eng
Subjects:	ABO Blood-Group System Adult Aged Brazil End Stage Liver Disease - immunology End Stage Liver Disease - surgery Female Health Services Accessibility - organization & administration Humans Liver Transplantation Male Middle Aged Patient Selection Severity of Illness Index Tissue and Organ Procurement - methods Tissue and Organ Procurement - organization & administration Waiting Lists
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Summary:	In the Model for End-Stage Liver Disease (MELD) system, patients with “MELD exceptions” points may have unfair privilege in the competition for liver grafts. Furthermore, organ distribution following identical ABO blood types may also result in unjust organ allocation. The aim of this study was to investigate access to liver transplantation in a tertiary Brazilian center, regarding “MELD exceptions” situations and among ABO-blood groups. A total of 465 adult patients on the liver waitlist from August 2015 to August 2016 were followed up until August 2017. Patients were divided into groups according to ABO-blood type and presence of “exceptions points.” No differences in outcomes were observed among ABO-blood groups. However, patients from B and AB blood types spent less time on the list than patients from A and O groups (median, 46, 176, 415, and 401 days, respectively; P = .03). “Exceptions points” were granted for 141 patients (30.1%), hepatocellular carcinoma being the most common reason (52.4%). Patients with “exceptions points” showed higher transplantation rate, lower mortality on the list, and lower delta-MELD than non-exceptions patients (56.7% vs 19.1% [P < .01]; 18.4% vs 38.5% [P < .01], and 2.0 ± 2.6 vs 6.9 ± 7.0 [P < .01], respectively). Patients with refractory ascites had a higher mortality rate than those with other “exceptions” or without (48%). The MELD system provides equal access to liver transplantation among ABO-blood types, despite shorter time on the waitlist for AB and B groups. The current MELD exception system provides advantages for candidates with “exception points,” resulting in superior outcomes compared with those without exceptions.
ISSN:	0041-1345 1873-2623