San Diego — Latest Model for End-Stage Liver Disease (MELD 3.0) Scoring System In July 2023, the Federal Organ Procurement and Transplant Network (OPTN) liver transplant According to new research, it's getting narrower.
In particular, women are now more likely to be added to a waiting list. liver transplantare more likely to receive a transplant and less likely to be taken off the waiting list due to death.
“MELD 3.0 has improved women's access to transplantation, and women's elective mortality and transplant rates are now much closer to men's rates,” said lead author, Stanford University Assistant Professor of Medicine and transplant liver specialist. said Alison Kwon, MD, Ph.D.
“Overall transplant outcomes are also improving year over year,” said Kwong, who presented the findings (Abstract 5002) at The Liver Meeting 2024: American Association for the Study of Liver Sciences (AASLD).
Changes in MELD and number of transplants
MELD, which estimates liver failure severity and short-term survival in patients with chronic liver disease, has been used since 2002 to prioritize organ allocation for patients on the waiting list in the United States. liver transplant. Initially, the score included three variables: creatinine, bilirubinand the International Normalized Ratio (INR). MELDNa1 (MELD 2.0) was adopted in 2016 to add sodium.
“However, under this system, there is a gender disparity,” Kwon said, noting that women receive lower priority scores despite similar disease severity. .
“This is thought to be due to several factors, including the creatinine terminology of the MELD score. Underestimating renal dysfunction For women, these include differences in height and body size, differences in disease etiology, and how exception points have been historically allocated,” she reported.
She added that men have lower pre-transplant mortality rates and higher transplant rates from deceased donors.
As previously reported, medscape medical news, MELD 3.0 was developed to address these gender differences and other determinants of waitlist outcomes. The updated equation added 1.33 points for women and also added other variables, including: albuminthe interaction between bilirubin and sodium, and the interaction between albumin and creatinine improve the prediction accuracy.
To observe the effectiveness of the new system, Kwong et al. analyzed OPTN data for patients 12 years of age and older, including more than 20,300 liver transplant candidates newly enrolled between 12 months and 12 months prior to liver transplantation. and focused on records of approximately 18,700 transplant recipients. A few months after MELD 3.0 was implemented.
After the switch, 43.7% of newly registered liver transplant candidates were women, compared with 40.4% before the switch. The median age at enrollment was 55 years both before and after the policy change, and the median MELD score changed from 23 to 22 after implementation.
Furthermore, 42.1% of transplants were performed in women after the introduction of MELD 3.0, compared to 37.3% before. Overall, deceased donor transplantation rates were similar for men and women after the introduction of MELD 3.0.
Kwon said the dropout rate from the 90-day waiting list (patients who died or became too ill to receive a transplant) decreased from 13.5% to 9.1% for women, but this was partially due to stated that it may be caused by MELD 3.0.
However, the dropout rate for men on the waiting list also decreased from 9.8% to 7.4%, she added, possibly due to an increase in the number of livers available due to technological advances such as machine perfusion.
Disparities still exist
Some disparities still exist. Although the total median MELD score at the time of transplant decreased from 29 to 27, the median score for women at the time of transplant was still higher at 29 compared to the median score of 27 for men.
“This shows that there may still be disparities in access to transplants between the sexes,” Kwon said. “There are still body size differences that can affect the probability of transplantation, and this will not be addressed in MELD 3.0.”
Additional transplant disparities exist related to other patient characteristics, such as age, race, and ethnicity.
Future versions of MELD may take these factors into account, said session moderator Alexander Krag, MD, MBA, Professor of Clinical Medicine, University of Southern Denmark, and Secretary General of the European Association for the Study of the Liver 2023-2025. .
“There are an infinite number of versions of MELD that you can create,” says Kwon. “It's still early to know how MELD 3.0 will help the system, but so far so good.”
in the comments to Medscape Medical NewsTamar Taddei, MD, PhD, professor of gastroenterology at Yale School of Medicine, who co-facilitated the session, noted the importance of using the MELD score to account for gender differences.
She said the study made MELD 3.0 a reality by reducing the disparities experienced by women who were underserved by previous scoring systems.
It's great to see that MELD 3.0 has narrowed the transplant gap and reduced waiting list dropouts for both men and women,” Taddei said. “This change is a no-brainer.”
Kwong, Krag, and Taddei report no relevant disclosures.
Carolyn Crist is a health and medical journalist reporting on the latest research for Medscape, MDedge, and WebMD.
