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Related Experiment Video

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Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach

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Quantifying Sex-Based Disparities in Liver Allocation.

Jayme E Locke¹, Brittany A Shelton¹, Kim M Olthoff²

¹Division of Transplantation, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham.

|May 21, 2020

Summary

This summary is machine-generated.

Sex disparities in liver transplant allocation persist, with women facing higher waitlist mortality and lower transplant rates. These inequities stem from the Model for End-stage Liver Disease (MELD) score

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Area of Science:

Transplantation research
Health equity
Organ allocation systems

Background:

Geographic inequities exist in liver allocation due to organ supply and demand.
The Model for End-stage Liver Disease (MELD) score system has faced scrutiny for these disparities.
Sex-based disparities in liver transplant allocation have not been fully quantified in relation to clinical and geographic factors.

Purpose of the Study:

To estimate the extent of sex disparity in liver transplant waitlist mortality.
To determine the proportion of sex disparity in deceased donor liver transplant (DDLT) access.
To associate these disparities with clinical and geographic characteristics.

Main Methods:

Retrospective cohort study of adult liver-only transplant listings (June 2013-March 2018).
Utilized data from the Organ Procurement and Transplantation Network.
Employed multivariate Cox proportional hazards regression and inverse odds ratio weighting.

Main Results:

Women comprised 36.1% of the 81,357 wait-listed adults.
Women had higher waitlist mortality (8.6% more likely) and lower DDLT rates (14.4% less likely) compared to men.
Candidate anthropometric and liver measurements showed the strongest association with sex-based disparities in both mortality and DDLT.

Conclusions:

Addressing only geographic disparities may not resolve sex-based inequities in liver transplantation.
The MELD score may not accurately reflect disease severity in women.
Current allocation systems may fail to adequately consider crucial patient measurements for women.