Reduced Access to Liver Transplantation in Women: Role of Height, MELD Exception Scores, and Renal Function Underestimation.
Reduced Access to Liver Transplantation in Women: Role of Height, MELD Exception Scores, and Renal Function Underestimation.
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DOI：
10.1097/tp.0000000000002196
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发表时间：
2018-10
期刊：
影响因子：
6.2
通讯作者：
Therneau TM
中科院分区：
文献类型：
--
作者：
Allen AM;Heimbach JK;Larson JJ;Mara KC;Kim WR;Kamath PS;Therneau TM
肝移植（LT）中基于性别的差异尚不完全清楚。我们评估了身高、MELD、MELD-Na 和异常点在不同的 LT 获取中的作用。 2002 年至 2013 年间在器官获取和移植网络 (OPTN) 中等待 LT 的成年人也被纳入其中。通过 Cox 比例模型分析与 LT 可能性相关的协变量。在一个单独的队列中，通过碘酞酸盐清除率测量肾小球滤过率 (GFR) 的成年人 (n=611)，我们确定了男性与女性中肌酐衍生的 MELD 点的数量，涵盖所有 GFR 范围。对纠正女性 MELD 分数缺陷对 LT 的影响进行了建模。在 90,720 名 OPTN 注册者中，女性的死亡率高于男性（上市后 4 年：22% vs 18%，p<0.0001），并且 LT 的可能性较低（49% vs 58%，p<0.0001）；女性接受移植的可能性降低 20%（HR= 0.80，95% CI= 0.78–0.81）。身高和 MELD 异常评分的差异是女性 LT 缺陷的主要原因（HR=0.91，95% CI 0.89-0.94）。与具有类似肾功能障碍的男性相比，女性获得的肌酐衍生 MELD 分数少 1 至 2.4 分。 MELD-Na 加剧了性别差异。向女性添加 1 或 2 个 MELD 分会显着影响 LT 的获得。身高和 MELD 例外点的差异解释了 LT 中大部分基于性别的差异。此外，MELD 评分低估了女性疾病的严重程度高达 2.4 分，而 MELD Na 则加剧了这种差异。基于MELD的低估程度对分配有显着影响。
Sex-based disparities in liver transplantation (LT) are incompletely understood. We assessed the role of height, MELD, MELD-Na and exception points in the disparate access to LT. Adults waitlisted for LT at Organ Procurement and Transplantation Network (OPTN) between 2002 and 2013 were included. Covariates associated with likelihood of LT were analyzed by Cox proportional model. In a separate cohort of waitlisted adults with glomerular filtration rate (GFR) measurement by iothalamate clearance (n=611), we determined the number of creatinine-derived MELD points in men vs women, across all ranges of GFR. The impact of correcting the MELD score deficit in women on LT was modeled. Among 90,720 OPTN registrants, women had higher mortality than men (4 years after listing: 22% vs 18%, p<0.0001), and lower likelihood of LT (49% vs 58%, p<0.0001); women were 20% less likely to be transplanted (HR= 0.80, 95% CI= 0.78–0.81). Differences in height and MELD exception scores accounted for most of the LT deficit in women (HR=0.91, 95% CI 0.89–0.94). Women received between 1 and 2.4 fewer creatinine-derived MELD points than men with similar renal dysfunction. MELD-Na worsened the gender disparity. Addition of 1 or 2 MELD points to women significantly impacted LT access. Differences in height and MELD exception points explained most of the sex-based disparity in LT. Additionally, MELD score underestimated disease severity in women by up to 2.4 points and MELD Na exacerbated this disparity. The degree of underestimation based on MELD had significant impact on allocation.