Leven Emily A, Li Ditian, Bagiella Emilia, Schiano Thomas D, Tal Grinspan Lauren
Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Population Health, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY.
Transplant Direct. 2025 Apr 9;11(5):e1781. doi: 10.1097/TXD.0000000000001781. eCollection 2025 May.
Sex disparities in solid organ transplantation are well documented. Relative changes in sex-based outcome disparities after the 2017 standardization of simultaneous liver-kidney (SLK) listing criteria in the United States have not been reported. We hypothesized that this policy's objective measures of kidney dysfunction may differentially affect SLK patients by sex and that the use of MELD 3.0 in the SLK population might provide unique benefit to female transplant candidates.
Organ Procurement and Transplantation Network data were retrospectively analyzed comparing 2013-2016 with 2018-2021 SLK listings. Waitlist outcomes and Model for End-stage Liver Disease (MELD) 3.0 reclassifications were compared by sex and listing period.
There were 2626 and 2609 male patients and 1670 and 1919 female patients pre- and post-policy changes, respectively. The proportion of female SLK listings post-policy change (42.4%) was higher than both female SLK listings pre-policy change (38.9%) and female single-organ liver listings post-policy change (36.8%; < 0.01). A statistically significant interaction between sex and listing group (pre- versus post-policy change) was present in multivariable analysis ( = 0.02). Female patients were more likely to have a higher MELD 3.0 score than the listing MELD/MELD-Na score when the listing MELD score was <30 ( < 0.01). Among all patients who died on the waitlist, female patients were nearly twice as likely to be underrepresented by listing MELD compared with MELD 3.0 (23% female and 13% male patients; < 0.01).
Waitlist outcomes were changed differentially between male and female patients after the 2017 SLK policy change. The application of MELD 3.0 to SLK patients is likely to benefit female patients.
实体器官移植中的性别差异已有充分记录。美国2017年同步肝肾（SLK）列入标准标准化后，基于性别的结局差异的相对变化尚未见报道。我们假设该政策对肾功能不全的客观衡量标准可能对不同性别的SLK患者产生不同影响，并且在SLK人群中使用终末期肝病模型（MELD）3.0可能会为女性移植候选人带来独特益处。
对器官获取与移植网络数据进行回顾性分析，比较2013 - 2016年与2018 - 2021年的SLK列入情况。按性别和列入时期比较等待名单结局及终末期肝病模型（MELD）3.0重新分类情况。
政策改变前后，男性患者分别有2626例和2609例，女性患者分别有1670例和1919例。政策改变后女性SLK列入比例（42.4%）高于政策改变前女性SLK列入比例（38.9%）以及政策改变后女性单器官肝列入比例（36.8%；P<0.01）。多变量分析显示性别与列入组（政策改变前与后）之间存在统计学显著交互作用（P = 0.02）。当列入MELD评分<30时，女性患者的MELD 3.0评分高于列入时的MELD/MELD-Na评分的可能性更大（P<0.01）。在所有等待名单上死亡的患者中，与MELD 3.0相比，列入MELD时女性患者代表性不足的可能性几乎是男性患者的两倍（女性患者为23%，男性患者为13%；P<0.01）。
2017年SLK政策改变后，男性和女性患者在等待名单上的结局变化存在差异。将MELD 3.0应用于SLK患者可能使女性患者受益。
