Has Sex‐Based Disparity in Liver Transplantation Opportunities and Waitlist Mortality Improved in the MELD3.0 Era?: A Preliminary Study
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2024
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| author | Miho Akabane Yuki Imaoka Carlos O. Esquivel Kazunari Sasaki |
| author_facet | Miho Akabane Yuki Imaoka Carlos O. Esquivel Kazunari Sasaki Miho Akabane Yuki Imaoka Carlos O. Esquivel Kazunari Sasaki |
| collection | Wiley Open Access |
| contents | Has Sex‐Based Disparity in Liver Transplantation Opportunities and Waitlist Mortality Improved in the MELD3.0 Era?: A Preliminary Study Miho Akabane Yuki Imaoka Carlos O. Esquivel Kazunari Sasaki Clinical Transplantation ABSTRACTBackgroundIn July 2023, the OPTN adopted MELD3.0 to address sex‐based disparities in liver transplantation (LT) opportunity and waitlist mortality. No studies have proven that MELD3.0 alleviated them.MethodsWe evaluated sex‐based disparities in LT opportunities and waitlist mortality, utilizing the UNOS data (August 2022–March 2024), comparing pre‐ and post‐MELD3.0 eras.ResultsAmong 11 795 LT candidates (pre‐MELD3.0: 7263; post‐MELD3.0: 4532), the proportion of females increased from 38.8% to 42.6% post‐MELD3.0. In the transplanted population, females increased from 37.7% to 41.6% post‐MELD3.0. The median MELD score difference (“MELD3.0–MELD‐Na”) at listing was ‐0.26 [‐2.13, 0.80] for females and ‐0.86 [‐2.92, 0.00] for males (p < 0.01). Compared to females, males consistently showed a larger drop in points from MELD‐Na to MELD3.0. In the pre‐MELD3.0 era, females had lower LT opportunity (sub‐hazard ratio [sHR]: 0.88 [0.83–0.93], p < 0.01) and higher waitlist mortality (sHR: 1.39 [1.20–1.62], p < 0.01). In the post‐MELD3.0 era, there were no significant differences in LT opportunity (sHR: 0.93 [0.87–1.00], p = 0.07) and waitlist mortality (sHR: 1.25 [0.98–1.57], p = 0.26). Subgroup analyses based on MELD‐Na groups showed that significant differences in LT opportunity and waitlist mortality in the pre‐MELD3.0 era became insignificant in the post‐MELD3.0 era. Multivariable competing‐risk analysis showed that, in the pre‐MELD3.0 era, female sex was a significant risk factor for LT opportunity (sHR: 0.90 [0.84–0.96], p < 0.01) and waitlist mortality (sHR: 1.19 [1.01–1.38], p = 0.03), but in the post‐MELD3.0 era, it was not significant (sHR: 0.94 [0.86–1.02], p = 0.11 for LT opportunity/sHR: 1.08 [0.83–1.40], p = 0.57 for waitlist mortality).ConclusionsOur preliminary findings suggest that MELD3.0 has the potential to reduce sex‐based disparities in LT opportunities and waitlist mortality. 10.1111/ctr.70064 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/ctr.70064 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70064 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2024 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Has Sex‐Based Disparity in Liver Transplantation Opportunities and Waitlist Mortality Improved in the MELD3.0 Era?: A Preliminary Study Miho Akabane Yuki Imaoka Carlos O. Esquivel Kazunari Sasaki Clinical Transplantation Has Sex‐Based Disparity in Liver Transplantation Opportunities and Waitlist Mortality Improved in the MELD3.0 Era?: A Preliminary Study Miho Akabane Yuki Imaoka Carlos O. Esquivel Kazunari Sasaki Clinical Transplantation ABSTRACTBackgroundIn July 2023, the OPTN adopted MELD3.0 to address sex‐based disparities in liver transplantation (LT) opportunity and waitlist mortality. No studies have proven that MELD3.0 alleviated them.MethodsWe evaluated sex‐based disparities in LT opportunities and waitlist mortality, utilizing the UNOS data (August 2022–March 2024), comparing pre‐ and post‐MELD3.0 eras.ResultsAmong 11 795 LT candidates (pre‐MELD3.0: 7263; post‐MELD3.0: 4532), the proportion of females increased from 38.8% to 42.6% post‐MELD3.0. In the transplanted population, females increased from 37.7% to 41.6% post‐MELD3.0. The median MELD score difference (“MELD3.0–MELD‐Na”) at listing was ‐0.26 [‐2.13, 0.80] for females and ‐0.86 [‐2.92, 0.00] for males (p < 0.01). Compared to females, males consistently showed a larger drop in points from MELD‐Na to MELD3.0. In the pre‐MELD3.0 era, females had lower LT opportunity (sub‐hazard ratio [sHR]: 0.88 [0.83–0.93], p < 0.01) and higher waitlist mortality (sHR: 1.39 [1.20–1.62], p < 0.01). In the post‐MELD3.0 era, there were no significant differences in LT opportunity (sHR: 0.93 [0.87–1.00], p = 0.07) and waitlist mortality (sHR: 1.25 [0.98–1.57], p = 0.26). Subgroup analyses based on MELD‐Na groups showed that significant differences in LT opportunity and waitlist mortality in the pre‐MELD3.0 era became insignificant in the post‐MELD3.0 era. Multivariable competing‐risk analysis showed that, in the pre‐MELD3.0 era, female sex was a significant risk factor for LT opportunity (sHR: 0.90 [0.84–0.96], p < 0.01) and waitlist mortality (sHR: 1.19 [1.01–1.38], p = 0.03), but in the post‐MELD3.0 era, it was not significant (sHR: 0.94 [0.86–1.02], p = 0.11 for LT opportunity/sHR: 1.08 [0.83–1.40], p = 0.57 for waitlist mortality).ConclusionsOur preliminary findings suggest that MELD3.0 has the potential to reduce sex‐based disparities in LT opportunities and waitlist mortality. 10.1111/ctr.70064 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Has Sex‐Based Disparity in Liver Transplantation Opportunities and Waitlist Mortality Improved in the MELD3.0 Era?: A Preliminary Study |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70064 |