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  1. Increasing Survival Results in High MELD Recipients, What We LearnedAndre I David, MD, PhD1, Allison Trevizol, Acad2, Rafael AA Pecora, MD1, Eduardo T Yamashita, Acad2, Rafael SN Pinheiro, MD1, Ruy JC Junior, MD, PhD1 , Luiz Augusto C D'Albuquerque, MD, PhD1. 1- Gastroenterology/Transplant - LIM 37, Faculdade de MedicinadaUniversidade de Sao Paulo, 2- Surgery, Santa Casa Medical School, Sao Paulo, Brazil. Introduction 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 analyzed 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. The high MELD patients had similar results of that with MELD > 30 in the last 14 months. (figure 2). Conclusion Providences like high investment in human resources, 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. Figure 1 • References • 1. SRTR website, http://srtr.transplant.hrsa.gov/annual_reports/2011/pdf/03_%20liver_12.pdf. • 2. Registro Brasileiro de Transplante [internet database ]. 2013. Availablefrom: http://www.abto.org.br/abtov03/Upload/file/RBT/2012/RBT-dimensionamento2012.pdf • RavaioliM, Grazi GL, Ercolani G, et al. The future challenge in the MELD era: how to match extended-use donors and sick recipients. Transplantation. 2006;7:987 • KamathPS, Kim WR. The Model for End-Stage Liver Disease. 2007;45(3):797-850. Printed by Figure 2

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