Systematic Sex-Based Inequity in the MELD Score-Based Allocation System for Liver Transplantation in Germany

被引：0
作者：
Wiering, Leke [1 ,2 ,3 ,4 ,5 ,6 ]
Aigner, Annette [1 ,2 ,7 ]
van Rosmalen, Marieke [8 ]
Globke, Brigitta [1 ,2 ,4 ,5 ,6 ,9 ]
Dziodzio, Tomasz [1 ,2 ,4 ,9 ]
Raschzok, Nathanael [1 ,2 ,4 ,5 ,9 ]
Demir, Muenevver [1 ,2 ,3 ,4 ]
Schoening, Wenzel [1 ,2 ,9 ]
Tacke, Frank [1 ,2 ,3 ,4 ]
Reinke, Petra [1 ,2 ,10 ]
Pratschke, Johann [1 ,2 ,4 ,9 ]
Oellinger, Robert [1 ,2 ,4 ,9 ]
Ritschl, Paul V. [1 ,2 ,4 ,5 ,9 ]
机构：
[1] Charite Univ Med Berlin, Berlin, Germany
[2] Free Univ Berlin, Berlin, Germany
[3] Humboldt Univ, Dept Hepatol & Gastroenterol, Berlin, Germany
[4] Campus Virchow Klinikum & Charite Campus Mitte, Berlin, Germany
[5] Charite Univ Med Berlin, Berlin Inst Hlth, Berlin, Germany
[6] BIH Biomed Innovat Acad, BIH Charite Jr Clinician Scientist Program, Berlin, Germany
[7] Humboldt Univ, Inst Biometry & Clin Epidemiol, Berlin, Germany
[8] Eurotransplant Int Fdn, Leiden, Netherlands
[9] Humboldt Univ, Dept Surg, Berlin, Germany
[10] Humboldt Univ, Berlin Ctr Adv Therapies BeCAT, Berlin, Germany
来源：
TRANSPLANT INTERNATIONAL | 2025年 / 38卷
关键词：
organ procurement and allocation; model for end-stage liver disease; end stage liver disease; disparities; gender; sex inequity; waiting list; access to transplantation; GENDER-DIFFERENCE; LIST MORTALITY; DISEASE; MODEL; DISPARITIES; SIZE; POLICY; RATES; DONOR;
D O I：
10.3389/ti.2025.13844
中图分类号：
R61 [外科手术学];
学科分类号：
摘要：
In liver allocation systems based on the Model for End-stage Liver Disease (MELD) score, sex inequities have been identified in countries with high organ donation rates. Whether similar inequities exist in regions with average to low donation rates remained unclear. We assessed the impact of sex on transplantation rates, waiting list mortality and post-transplant survival in 25,943 patients waitlisted for liver transplantation in Germany between 2003 and 2017 using competing risk analysis. Women are currently underrepresented on the waiting list (33.3%) and among transplant recipients (31.1%) compared to their proportion of severe liver disease cases (35.1%). The introduction of MELD-based allocation has worsened this disadvantage [HR before: 0.89 (0.81-0.98), after: 0.77 (0.74-0.81)]. Three key factors contribute to this disparity: Women have lower creatinine levels despite worse renal function, reducing their MELD score (median 1, 0-3). Second, exceptional MELD points are more frequently granted to men [HR 1.61 (1.54-1.69) compared to regular allocation]. Third, the small height of women has the highest impact on the probability of not being transplanted [adjusted HR 0.85 (0.81-0.9)]. Even in countries with lower organ donation rates, MELD-based allocation leads to sex inequity. Measures are needed to ensure sex-neutral liver allocation in MELD-based systems worldwide.
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页数：10
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共 40 条
[31]  
Northup P.G., Intagliata N.M., Shah N.L., Pelletier S.J., Berg C.L., Argo C.K., Excess Mortality on the Liver Transplant Waiting List: Unintended Policy Consequences and Model for End-Stage Liver Disease (MELD) Inflation, Hepatology, 61, 1, pp. 285-291, (2015)
[32]  
Massie A.B., Caffo B., Gentry S.E., Hall E.C., Axelrod D.A., Lentine K.L., Et al., MELD Exceptions and Rates of Waiting List Outcomes, Am J Transpl, 11, 11, pp. 2362-2371, (2011)
[33]  
Lok A.S., Seeff L.B., Morgan T.R., di Bisceglie A.M., Sterling R.K., Curto T.M., Et al., Incidence of Hepatocellular Carcinoma and Associated Risk Factors in Hepatitis C-Related Advanced Liver Disease, Gastroenterology, 136, 1, pp. 138-148, (2009)
[34]  
Huo S.C., Huo T.I., Lin H.C., Chi C.W., Lee P.C., Tseng F.W., Et al., Is the Corrected-Creatinine Model for End-Stage Liver Disease a Feasible Strategy to Adjust Gender Difference in Organ Allocation for Liver Transplantation?, Transplantation, 84, 11, pp. 1406-1412, (2007)
[35]  
Myers R.P., Shaheen A.A., Aspinall A.I., Quinn R.R., Burak K.W., Gender, Renal Function, and Outcomes on the Liver Transplant Waiting List: Assessment of Revised MELD Including Estimated Glomerular Filtration Rate, J Hepatol, 54, 3, pp. 462-470, (2011)
[36]  
Asrani S.K., Jennings L.W., Kim W.R., Kamath P.S., Levitsky J., Nadim M.K., Et al., MELD-GRAIL-Na: Glomerular Filtration Rate and Mortality on Liver-Transplant Waiting List, Hepatology, 71, 5, pp. 1766-1774, (2020)
[37]  
Mindikoglu A.L., Regev A., Seliger S.L., Magder L.S., Gender Disparity in Liver Transplant Waiting-List Mortality: The Importance of Kidney Function, Liver Transpl, 16, 10, pp. 1147-1157, (2010)
[38]  
Herden U., Grabhorn E., Briem-Richter A., Ganschow R., Nashan B., Fischer L., Developments in Pediatric Liver Transplantation since Implementation of the New Allocation Rules in Eurotransplant, Clin Transpl, 28, 9, pp. 1061-1068, (2014)
[39]  
Verna E.C., Lai J.C., Time for Action to Address the Persistent Sex-Based Disparity in Liver Transplant Access, JAMA Surg, 155, 7, pp. 545-547, (2020)
[40]  
Tejedor M., Neria F., De La Rosa G., Almohalla Alvarez C., Padilla M., Bosca Robledo A., Et al., Women Are Also Disadvantaged in Accessing Transplant outside the United States: Analysis of the Spanish Liver Transplantation Registry, Transpl Int, 37, (2024)
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