Correcting the sex disparity in MELD-Na

Area of Science:

• Transplantation research
• Medical statistics
• Health equity

Background:

• The Model for End-Stage Liver Disease with Sodium (MELD-Na) score is crucial for liver transplant allocation.
• Existing MELD-Na scoring may disadvantage women by inaccurately reflecting their mortality risk.
• Addressing sex-based disparities in liver transplant access is a critical public health concern.

Purpose of the Study:

• To quantify the sex-based disadvantage in MELD-Na scoring for liver transplant candidates.
• To develop and evaluate a corrected MELD-Na score that eliminates sex disparities.
• To assess the impact of score corrections on transplant and mortality rates using simulation.

Main Methods:

• Kaplan-Meier modeling to calculate 90-day without-transplant survival for men and women at each MELD-Na score.
• Testing of proposed MELD-Na corrections (MELD-Na-MDRD, MELD-GRAIL-Na) and a novel correction (MELD-Na-Shift).
• Evaluation of correction effectiveness using a simulated liver allocation model.

Main Results:

• Women experienced higher mortality risk than men across most MELD-Na scores (15-35).
• MELD-Na-MDRD overcorrected sex differences; MELD-GRAIL-Na and MELD-Na-Shift successfully eliminated disparities in survival.
• MELD-Na-Shift simulation demonstrated elimination of sex disparity in transplant (p=0.4044) and mortality (p=0.7070) rates.

Conclusions:

• A corrected MELD-Na score, specifically MELD-Na-Shift, can eliminate sex disparities in liver transplant outcomes.
• Further allocation adjustments, such as prioritizing shorter candidates for smaller livers, may be necessary.
• Equitable access to liver transplantation requires continuous refinement of allocation algorithms and consideration of patient characteristics.