Akabane Miho, Imaoka Yuki, Esquivel Carlos O, Sasaki Kazunari
Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA.
Clin Transplant. 2025 Jan;39(1):e70064. doi: 10.1111/ctr.70064.
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.
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.
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).
Our preliminary findings suggest that MELD3.0 has the potential to reduce sex-based disparities in LT opportunities and waitlist mortality.
2023年7月，器官共享联合网络（OPTN）采用了终末期肝病模型3.0（MELD3.0）来解决肝移植（LT）机会和等待名单死亡率方面的性别差异问题。尚无研究证明MELD3.0缓解了这些差异。
我们利用器官共享联合网络（UNOS）的数据（2022年8月至2024年3月），比较MELD3.0时代前后，评估LT机会和等待名单死亡率方面的性别差异。
在11795例LT候选者中（MELD3.0之前：7263例；MELD3.0之后：4532例），MELD3.0之后女性的比例从38.8%增至42.6%。在移植人群中，MELD3.0之后女性从37.7%增至41.6%。登记时女性的中位MELD评分差值（“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的评分降幅始终更大。在MELD3.0之前的时代，女性LT机会较低（亚风险比[sHR]：0.88 [0.83 - 0.93]，p < 0.01）且等待名单死亡率较高（sHR：1.39 [1.20 - 1.62]，p < 0.01）。在MELD3.0之后的时代，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分组的亚组分析显示，MELD3.0之前时代LT机会和等待名单死亡率的显著差异在MELD3.0之后时代变得不显著。多变量竞争风险分析显示，在MELD3.0之前的时代，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）的显著风险因素，但在MELD3.0之后的时代则不显著（LT机会的sHR：|0.94 [0.86 - 1.02]，p = 0.11/等待名单死亡率的sHR：1.08 [0.83 - 1.40]，p = 0.57）。
我们的初步研究结果表明，MELD3.0有可能减少LT机会和等待名单死亡率方面的性别差异。
