Revising the MELD Score to Address Sex-Bias in Liver Transplant Prioritization for a German Cohort.

Autor:	Walter Costa MB; Clinical Chemistry and Molecular Diagnostics, Institute for Laboratory Medicine, Leipzig University Medical Center, Paul-List-Straße 13/15, D-04103 Leipzig, Germany.; Viral Ecology and Omics, Institute of Biodiversity, Faculty of Biological Sciences, Friedrich Schiller University Jena, Rosalind-Franklin Straße 1, D-07745 Jena, Germany., Gärtner C; Viral Ecology and Omics, Institute of Biodiversity, Faculty of Biological Sciences, Friedrich Schiller University Jena, Rosalind-Franklin Straße 1, D-07745 Jena, Germany.; Academic Department of Laboratory Medicine, Microbiology and Pathobiochemistry, Medical School and University Medical Center East Westphalia-Lippe, Hospital Lippe, Bielefeld University, Röntgenstraße 18, D-32756 Detmold, Germany., Schmidt M; Clinical Chemistry and Molecular Diagnostics, Institute for Laboratory Medicine, Leipzig University Medical Center, Paul-List-Straße 13/15, D-04103 Leipzig, Germany., Berg T; Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, D-04103 Leipzig, Germany., Seehofer D; Division of Hepatobiliary Surgery and Visceral Transplant Surgery, Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Medical Center, Liebigstraße 20, D-04103 Leipzig, Germany., Kaiser T; Clinical Chemistry and Molecular Diagnostics, Institute for Laboratory Medicine, Leipzig University Medical Center, Paul-List-Straße 13/15, D-04103 Leipzig, Germany.; Academic Department of Laboratory Medicine, Microbiology and Pathobiochemistry, Medical School and University Medical Center East Westphalia-Lippe, Hospital Lippe, Bielefeld University, Röntgenstraße 18, D-32756 Detmold, Germany.
Jazyk:	angličtina
Zdroj:	Journal of personalized medicine [J Pers Med] 2023 Jun 07; Vol. 13 (6). Date of Electronic Publication: 2023 Jun 07.
DOI:	10.3390/jpm13060963
Abstrakt:	(1) Background: Prioritization of patients for liver transplantation in Germany relies on the MELD (model for end-stage liver disease) scoring system that does not consider the patient's sex. Many studies have shown that women are disadvantaged by the MELD score. Using a large patient cohort from a German liver transplant centre, we investigated options to reduce gender inequality in the patient prioritization for liver transplantation. (2) Methods: We calculated female-as-male MELD scores in our cohort by substituting the serum creatinine of a female patient with that of their male equivalent to test for the fairness of the scores. We investigated the effects of the female-as-male scores compared to the original MELD score of 1759 patients listed for liver transplantation. (3) Results: Serum creatinine sex correction (female-as-male) for MELD scores added up to 5.4 points in females, while the median changed by +1.6 points for females. We identified 72 females with an original MELD score < 20, for whom the adjusted female-as-male MELD score would be >20, thus giving them a better chance to receive a liver transplant. (4) Conclusions: Mathematical conversion of female to male creatinine concentrations identified disadvantages in liver transplantation prioritization for females and ascertained MELD 3.0 as having high potential to compensate for these inequalities.
Databáze:	MEDLINE
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