Adamantou Magdalini, Oikonomou Theodora, Petridou Nedia Georgia, Kalligiannakis Panagiotis, Chologkitas Christos, Kalpoutzakis Michail, Kavalaki Maria Christina, Glaros Dimitrios, Michelis Evangelinos, Papageorgiou Apostolos, Papatheodoridis George V, Goulis Ioannis, Cholongitas Evangelos
First Department of Internal Medicine, Medical School, National and Kapodistrian University, Athens (Magdalini Adamantou, Nedia Georgia Petridou, Panagiotis Kalligiannakis, Christos Chologkitas, Michail Kalpoutzakis, Maria Christina Kavalaki, Dimitrios Glaros, Evangelinos Michelis, Apostolos Papageorgiou, Evangelos Cholongitas).
4 Department of Internal Medicine, "Hippocration" General Hospital of Thessaloniki, Aristotelion University of Thessaloniki, Thessaloniki (Ioannis Goulis, Theodora Oikonomou).
Ann Gastroenterol. 2025 Jan-Feb;38(1):93-99. doi: 10.20524/aog.2024.0933. Epub 2024 Dec 12.
The current allocation system for liver transplantation (LT) is based on the sickest-first policy, using objective variables to ensure equal priority. However, under-prioritization of female patients for LT, compared to males, is well demonstrated and new scores have been proposed to overcome this systematic bias. This study evaluated the ability of these new scores to predict the long-term outcomes of patients with cirrhosis.
The clinical and laboratory characteristics of 694 consecutive candidates for liver transplantation from 2 liver transplant centers were recorded. The model for end-stage liver disease (MELD)-based scores (MELD, MELD-Sodium and MELD 3.0), as well as the Gender-Equity Model for liver Allocation (GEMA) and GEMA-Sodium, were used to assess the severity of liver disease. Patients were followed-up prospectively and their outcomes assessed.
During a follow-up period of median length 12 months (range: 4-52), 28.5% of patients died, 21% of patients underwent LT, while 50.5% remained alive. Female patients had significantly lower MELD and MELD-Sodium scores compared to males, attributable to their significantly lower creatinine, while MELD 3.0, GEMA and GEMA-Sodium did not differ between the 2 sexes. In multivariate Cox regression analysis, GEMA-Sodium was the only factor independently associated with death/LT, and showed very good discriminative ability (hazard ratio 1.10, 95% confidence interval 1.073-1.128; P<0.001). These findings were confirmed in several subgroup analyses.
Our findings show for the first time the predictive ability of GEMA-Sodium for the long-term outcomes of LT candidates. However, further studies are needed to confirm these findings.
当前的肝移植（LT）分配系统基于病情最严重优先的政策，使用客观变量来确保平等的优先级。然而，与男性相比，女性患者在LT中优先级较低的情况已得到充分证明，并且已经提出了新的评分系统来克服这种系统性偏差。本研究评估了这些新评分系统预测肝硬化患者长期预后的能力。
记录了来自2个肝移植中心的694例连续肝移植候选者的临床和实验室特征。基于终末期肝病模型（MELD）的评分（MELD、MELD-钠和MELD 3.0），以及肝分配性别平等模型（GEMA）和GEMA-钠，用于评估肝病的严重程度。对患者进行前瞻性随访并评估其预后。
在中位随访期12个月（范围：4 - 52个月）内，28.5%的患者死亡，21%的患者接受了LT，而50.5%的患者仍存活。与男性相比，女性患者的MELD和MELD-钠评分显著较低，这归因于她们的肌酐水平显著较低，而MELD 3.0、GEMA和GEMA-钠在两性之间没有差异。在多变量Cox回归分析中，GEMA-钠是唯一与死亡/LT独立相关的因素，并且显示出非常好的判别能力（风险比1.10，95%置信区间1.073 - 1.128；P<0.001）。这些发现在几个亚组分析中得到了证实。
我们的研究结果首次表明GEMA-钠对LT候选者长期预后的预测能力。然而，需要进一步的研究来证实这些发现。
