Division of Gastroenterology and Hepatology, University of California, San Francisco, CA, USA.
Am J Transplant. 2010 Dec;10(12):2658-64. doi: 10.1111/j.1600-6143.2010.03326.x. Epub 2010 Nov 18.
This study examined factors associated with the gender disparity in wait-list mortality in the MELD era. Adult patients listed for liver transplantation from 2002 to 2008 were included. Females [12 585(36%)] and males [22 126(64%)] differed clinically by age (54 vs. 52 years), height (1.6 vs. 1.8 m), listing estimated glomerular filtration rate [(eGFR); 70 vs. 83 mL/min] and cirrhosis etiology. Holding MELD constant, females were at 19% (95% CI, 1.13-1.25, p < 0.001) higher risk of wait-list mortality than males under the current allocation system. The relative hazard increased with worsening renal function, whether measured by serum creatinine or eGFR. Adjustment for MELD, age, African-American race, cirrhosis etiology, region and ABO group attenuated this relative hazard (HR 1.16; 95% CI, 1.10-1.22; p < 0.001) but additional adjustment for height completely explained this gender disparity in wait-list mortality (HR 1.05; 95% CI, 0.98-1.12; p = 0.2). Transplantation rates, however, remained lower among females, even after adjustment for height (HR 0.88; 95% CI, 0.82-0.92; p < 0.001). In conclusion, under the current liver allocation system, women have a 19% increased risk of wait-list mortality compared to men with the same MELD scores. Height contributes to this gender disparity, possibly reflecting differences in transplantation rates for shorter individuals.
本研究旨在探讨 MELD 时代等待名单死亡率性别差异的相关因素。纳入 2002 年至 2008 年接受肝移植的成年患者。女性[12585 例（36%）]和男性[22126 例（64%）]在年龄（54 岁比 52 岁）、身高（1.6 米比 1.8 米）、登记肾小球滤过率[eGFR；70 毫升/分比 83 毫升/分]和肝硬化病因方面存在差异。在 MELD 不变的情况下，当前分配系统下，女性等待名单死亡率比男性高 19%（95%可信区间，1.13-1.25，p<0.001）。无论采用血清肌酐还是 eGFR 来衡量，肾功能恶化时，相对危险度均升高。调整 MELD、年龄、非裔美国人种族、肝硬化病因、地区和 ABO 组后，该相对危险度降低（HR 1.16；95%可信区间，1.10-1.22；p<0.001），但进一步调整身高后，完全解释了等待名单死亡率的性别差异（HR 1.05；95%可信区间，0.98-1.12；p=0.2）。然而，即使调整了身高，女性的移植率仍然较低（HR 0.88；95%可信区间，0.82-0.92；p<0.001）。总之，在当前的肝脏分配系统下，女性与 MELD 评分相同的男性相比，等待名单死亡率增加了 19%。身高导致了这种性别差异，可能反映了身高较矮者的移植率差异。
