Has Sex-Based Disparity in Liver Transplantation Opportunities and Waitlist Mortality Improved in the MELD3.0 Era?: A Preliminary Study

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-12-31 DOI:10.1111/ctr.70064

Miho Akabane, Yuki Imaoka, Carlos O. Esquivel, Kazunari Sasaki

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Abstract

Background

In 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.

Methods

We 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.

Results

Among 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).

Conclusions

Our preliminary findings suggest that MELD3.0 has the potential to reduce sex-based disparities in LT opportunities and waitlist mortality.

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在MELD3.0时代，基于性别的肝移植机会差异和等待名单死亡率是否有所改善？：初步研究。

背景：2023年7月，OPTN采用MELD3.0来解决肝移植（LT）机会和等待名单死亡率的性别差异。没有研究证明MELD3.0可以缓解这些症状。方法：我们利用UNOS数据（2022年8月至2024年3月），比较meld3.0之前和之后的时代，评估了基于性别的LT机会和等待名单死亡率差异。结果：在11795名LT候选人中(meld3.0前：7263；meld3.0后：4532)，女性比例从38.8%上升到42.6%。在移植人群中，雌性在meld3.0后从37.7%增加到41.6%。女性MELD评分中位差（“MELD3.0-MELD-Na”）为-0.26[-2.13,0.80]，男性为-0.86 [-2.92,0.00]（p < 0.01）。与女性相比，男性从MELD-Na到MELD3.0的分数下降幅度一贯较大。在meld3.0之前，女性的LT机会较低（亚危险比[sHR]: 0.88 [0.83-0.93], p < 0.01），等待名单死亡率较高（sHR: 1.39 [1.20-1.62], p < 0.01）。在后meld3.0时代，LT机会（sHR: 0.93 [0.87-1.00], p = 0.07）和等待名单死亡率（sHR: 1.25 [0.98-1.57], p = 0.26）无显著差异。基于MELD-Na组的亚组分析显示，meld3.0时代之前的LT机会和等待名单死亡率的显著差异在meld3.0时代之后变得不显著。多变量竞争风险分析结果显示，在meld3.0时代前，女性性别是LT机会（sHR: 0.90 [0.84-0.96], p < 0.01）和等待名单死亡率（sHR: 1.19 [1.01-1.38], p = 0.03）的显著危险因素，但在meld3.0时代后，女性性别不显著（sHR: 0.94 [0.86-1.02], p = 0.11， LT机会/sHR: 1.08 [0.83-1.40], p = 0.57）。结论：我们的初步研究结果表明，MELD3.0有可能减少基于性别的LT机会差异和等待名单死亡率。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.