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Reuters Health Information (2008-11-25): Race, not gender disparities disappear with liver transplant scoring system


Race, not gender disparities disappear with liver transplant scoring system

Last Updated: 2008-11-25 16:00:08 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Before the Model for End-Stage Liver Disease (MELD) scoring system was introduced in February 2002, black patients were less likely to receive a liver transplant than their white counterparts. Now, new research suggests that use of the MELD score has eliminated this racial disparity.

On the other hand, the MELD system seemed to have little effect on gender disparities; women continue to be less likely than men to receive a liver transplant, according to the report in the Journal of the American Medical Association for November 26.

The MELD score uses objective laboratory data to estimate a transplant candidate's risk of death within the next 3 months. Patients with a higher MELD score, which indicates more severe disease, are placed higher on the transplant waiting list, regardless of how long they have been on the list.

In the current study, Dr. Cynthia A. Moylan, from Duke University Medical Center, Durham, North Carolina, and colleagues analyzed data from over 45,000 patients who were placed on the United Network for Organ Sharing liver transplantation waiting list in the years before and after the MELD system was implemented.

Prior to MELD, blacks were more likely than whites to die or become too sick for liver transplantation within 3 years of list placement: 27.0% vs. 21.7% (p = 0.003). In the post-MELD era, the corresponding percentages were 26.5% and 22.0%, a difference that was no longer statistically significant.

After the MELD system was in place, blacks were actually slightly more likely to receive a liver transplant than whites, although again the difference was not statistically significant: 47.5% vs. 45.5%. Before MELD, the percentages were 61.6% and 66.9%.

By contrast, for women, use of the MELD system was actually associated with an increased risk of death or becoming too sick for transplantation relative to men.

Similarly, before MELD, the liver transplantation rates for women and men within 3 years of list placement were 64.8% and 67.6%, respectively (p = 0.002). After MELD, the rates were 39.9% and 48.7% (p < 0.001).

"The current MELD system is clearly a step toward achieving the goal of an equitable, efficient, and transparent organ allocation system," Dr. David A. Axelrod, from Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and Dr. Elizabeth A. Pomfret, from the Lahey Clinic Medical Center, Burlington, Massachusetts, write in a related editorial.

"Modest differences based on sex persist, but could be addressed by revisions in the organ allocation policy to ensure that MELD scores are comparable across sexes."

JAMA 2008;300:2371-2378,2425-2426.

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