在终末期肝病模型（MELD）3.0时代，肝移植机会和等待名单死亡率方面基于性别的差异是否有所改善？一项初步研究。
Has Sex-Based Disparity in Liver Transplantation Opportunities and Waitlist Mortality Improved in the MELD3.0 Era?: A Preliminary Study.
作者信息
Akabane Miho, Imaoka Yuki, Esquivel Carlos O, Sasaki Kazunari
机构信息
Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA.
出版信息
Clin Transplant. 2025 Jan;39(1):e70064. doi: 10.1111/ctr.70064.
BACKGROUND
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.
METHODS
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.
RESULTS
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).
CONCLUSIONS
Our preliminary findings suggest that MELD3.0 has the potential to reduce sex-based disparities in LT opportunities and waitlist mortality.
背景
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。
方法
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。
结果
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）。
结论
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。
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