Rodríguez-Perálvarez Manuel Luis, de la Rosa Gloria, Gómez-Orellana Antonio Manuel, Aguilera María Victoria, Pascual Vicente Teresa, Pereira Sheila, Ortiz María Luisa, Pagano Giulia, Suarez Francisco, González Grande Rocío, Cachero Alba, Tomé Santiago, Barreales Mónica, Martín Mateos Rosa, Pascual Sonia, Romero Mario, Bilbao Itxarone, Alonso Martín Carmen, Otón Elena, González Diéguez Luisa, Espinosa María Dolores, Arias Milla Ana, Blanco Fernández Gerardo, Lorente Sara, Cuadrado Lavín Antonio, Redín García Amaya, Sánchez Cano Clara, Cepeda-Franco Carmen, Pons José Antonio, Colmenero Jordi, Guijo-Rubio David, Otero Alejandra, Amador Navarrete Alberto, Romero Moreno Sarai, Rodríguez Soler María, Hervás Martínez César, Gastaca Mikel
Department of Hepatology and Liver Transplantation, Hospital Universitario Reina Sofía, IMIBIC, Avda. Menéndez Pidal s/n, 14014, Córdoba, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Monforte de Lemos 3-5, 28029, Madrid, Spain.
EClinicalMedicine. 2024 Jul 18;74:102737. doi: 10.1016/j.eclinm.2024.102737. eCollection 2024 Aug.
The Gender-Equity Model for liver Allocation corrected by serum sodium (GEMA-Na) and the Model for End-stage Liver Disease 3.0 (MELD 3.0) could amend sex disparities for accessing liver transplantation (LT). We aimed to assess these inequities in Spain and to compare the performance of GEMA-Na and MELD 3.0.
Nationwide cohort study including adult patients listed for a first elective LT (January 2016-December 2021). The primary outcome was mortality or delisting for sickness within the first 90 days. Independent predictors of the primary outcome were evaluated using multivariate Cox's regression with adjusted relative risks (RR) and 95% confidence intervals (95% CI). The discrimination of GEMA-Na and MELD 3.0was assessed using Harrell c-statistics (Hc).
The study included 6071 patients (4697 men and 1374 women). Mortality or delisting for clinical deterioration occurred in 286 patients at 90 days (4.7%). Women had reduced access to LT (83.7% vs. 85.9%; p = 0.037) and increased risk of mortality or delisting for sickness at 90 days (adjusted RR = 1.57 [95% CI 1.09-2.28]; p = 0.017). Female sex remained as an independent risk factor when using MELD or MELD-Na but lost its significance in the presence of GEMA-Na or MELD 3.0. Among patients included for reasons other than tumours (n = 3606; 59.4%), GEMA-Na had Hc = 0.753 (95% CI 0.715-0.792), which was higher than MELD 3.0 (Hc = 0.726 [95% CI 0.686-0.767; p = 0.001), showing both models adequate calibration.
GEMA-Na and MELD 3.0 might correct sex disparities for accessing LT, but GEMA-Na provides more accurate predictions of waiting list outcomes and could be considered the standard of care for waiting list prioritization.
Instituto de Salud Carlos III, Agencia Estatal de Investigación (Spain), and European Union.
经血清钠校正的肝脏分配性别平等模型（GEMA-Na）和终末期肝病模型3.0（MELD 3.0）可修正肝移植（LT）中的性别差异。我们旨在评估西班牙的这些不平等情况，并比较GEMA-Na和MELD 3.0的性能。
全国队列研究，纳入首次择期LT登记的成年患者（2016年1月至2021年12月）。主要结局是90天内的死亡或因疾病退出登记。使用多变量Cox回归评估主要结局的独立预测因素，并调整相对风险（RR）和95%置信区间（95%CI）。使用Harrell c统计量（Hc）评估GEMA-Na和MELD 3.0的辨别力。
该研究纳入6071例患者（4697例男性和1374例女性）。286例患者在90天时出现死亡或因临床恶化退出登记（4.7%）。女性接受LT的机会减少（83.7%对85.9%；p = 0.037），且90天时死亡或因疾病退出登记的风险增加（调整后RR = 1.57 [95%CI 1.09 - 2.28]；p = 0.017）。使用MELD或MELD-Na时，女性性别仍是独立危险因素，但在使用GEMA-Na或MELD 3.0时失去其显著性。在因肿瘤以外原因纳入的患者中（n = 3606；59.4%），GEMA-Na的Hc = 0.753（95%CI 0.715 - 0.792），高于MELD 3.0（Hc = 0.726 [95%CI 0.686 - 0.767；p = 0.001]），表明两种模型校准良好。
GEMA-Na和MELD 3.0可能修正LT中的性别差异，但GEMA-Na对等待名单结局提供更准确的预测，可被视为等待名单优先排序的护理标准。
卡洛斯三世健康研究所、西班牙国家研究机构和欧盟。
