Sex-based Disparities in Access to Liver Transplantation for Waitlisted Patients With Model for End-stage Liver Disease Score of 40.

Autor:	Cron DC; Department of Surgery, Massachusetts General Hospital, Boston, MA.; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA., Braun HJ; Division of Transplantation, Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA., Ascher NL; Division of Transplantation, Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA., Yeh H; Department of Surgery, Massachusetts General Hospital, Boston, MA., Chang DC; Department of Surgery, Massachusetts General Hospital, Boston, MA., Adler JT; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.; Division of Transplantation, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Jan 01; Vol. 279 (1), pp. 112-118. Date of Electronic Publication: 2023 Jun 27.
DOI:	10.1097/SLA.0000000000005933
Abstrakt:	Objective: To determine the association of sex with access to liver transplantation among candidates with the highest possible model for end-stage liver disease score (MELD 40). Background: Women with end-stage liver disease are less likely than men to receive liver transplantation due in part to MELD's underestimation of renal dysfunction in women. The extent of the sex-based disparity among patients with high disease severity and equally high MELD scores is unclear. Methods: Using national transplant registry data, we compared liver offer acceptance (offers received at match MELD 40) and waitlist outcomes (transplant vs death/delisting) by sex for 7654 waitlisted liver transplant candidates from 2009 to 2019 who reached MELD 40. Multivariable logistic and competing-risks regression was used to estimate the association of sex with the outcome and adjust for the candidate and donor factors. Results: Women (N = 3019, 39.4%) spent equal time active at MELD 40 (median: 5 vs 5 days, P = 0.28) but had lower offer acceptance (9.2% vs 11.0%, P < 0.01) compared with men (N = 4635, 60.6%). Adjusting for candidate/donor factors, offers to women were less likely accepted (odds ratio = 0.87, P < 0.01). Adjusting for candidate factors, once they reached MELD 40, women were less likely to be transplanted (subdistribution hazard ratio = 0.90, P < 0.01) and more likely to die or be delisted (subdistribution hazard ratio = 1.14, P = 0.02). Conclusions: Even among candidates with high disease severity and equally high MELD scores, women have reduced access to liver transplantation and worse outcomes compared with men. Policies addressing this disparity should consider factors beyond MELD score adjustments alone. Competing Interests: The authors report no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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