Height Contributes to the Gender Difference in Wait-List Mortality Under the MELD-Based Liver Allocation System
Height Contributes to the Gender Difference in Wait-List Mortality Under the MELD-Based Liver Allocation System
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DOI：
10.1111/j.1600-6143.2010.03326.x
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发表时间：
2010-12-01
影响因子：
8.8
通讯作者：
Biggins, S. W.
中科院分区：
文献类型：
--
作者：
Lai, J. C.;Terrault, N. A.;Biggins, S. W.
本研究考察了与MELD时代等待名单死亡率性别差异相关的因素。纳入2002 - 2008年登记的肝移植成人患者。女性[12 585(36%)]和男性[22 126(64%)]在年龄（54岁对52岁）、身高（1.6米对1.8米）、肾小球滤过率（eGFR）等方面存在临床差异；70 vs 83 mL/min]和肝硬化病因学。保持MELD不变，在目前的分配制度下，女性的等候名单死亡率比男性高19% （95% CI, 1.13-1.25, p < 0.001）。无论用血清肌酐还是eGFR测量，相对危险性都随着肾功能的恶化而增加。调整MELD、年龄、非裔美国人种族、肝硬化病因、地区和ABO血型降低了这种相对风险（HR 1.16; 95% CI, 1.10-1.22; p < 0.001），但额外调整身高完全解释了等候名单死亡率的性别差异（HR 1.05; 95% CI, 0.98-1.12; p = 0.2）。然而，即使在调整身高后，女性的移植率仍然较低（HR 0.88; 95% CI, 0.82-0.92; p < 0.001）。综上所述，在目前的肝脏分配系统下，与MELD评分相同的男性相比，女性在等待名单上的死亡率增加了19%。身高造成了这种性别差异，可能反映了矮个子个体移植率的差异。
This study examined factors associated with the gender disparity in wait-list mortality in the MELD era. Adult patients listed for liver transplantation from 2002 to 2008 were included. Females [12 585(36%)] and males [22 126(64%)] differed clinically by age (54 vs. 52 years), height (1.6 vs. 1.8 m), listing estimated glomerular filtration rate [(eGFR); 70 vs. 83 mL/min] and cirrhosis etiology. Holding MELD constant, females were at 19% (95% CI, 1.13-1.25, p < 0.001) higher risk of wait-list mortality than males under the current allocation system. The relative hazard increased with worsening renal function, whether measured by serum creatinine or eGFR. Adjustment for MELD, age, African-American race, cirrhosis etiology, region and ABO group attenuated this relative hazard (HR 1.16; 95% CI, 1.10-1.22; p < 0.001) but additional adjustment for height completely explained this gender disparity in wait-list mortality (HR 1.05; 95% CI, 0.98-1.12; p = 0.2). Transplantation rates, however, remained lower among females, even after adjustment for height (HR 0.88; 95% CI, 0.82-0.92; p < 0.001). In conclusion, under the current liver allocation system, women have a 19% increased risk of wait-list mortality compared to men with the same MELD scores. Height contributes to this gender disparity, possibly reflecting differences in transplantation rates for shorter individuals.