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Revising the MELD Score to Address Sex-Bias in Liver Transplant Prioritization for a German Cohort

(1) Background: Prioritization of patients for liver transplantation in Germany relies on the MELD (model for end-stage liver disease) scoring system that does not consider the patient’s sex. Many studies have shown that women are disadvantaged by the MELD score. Using a large patient cohort from a...

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Autores principales: Walter Costa, Maria Beatriz, Gärtner, Christiane, Schmidt, Maria, Berg, Thomas, Seehofer, Daniel, Kaiser, Thorsten
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304409/
https://www.ncbi.nlm.nih.gov/pubmed/37373952
http://dx.doi.org/10.3390/jpm13060963
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author Walter Costa, Maria Beatriz
Gärtner, Christiane
Schmidt, Maria
Berg, Thomas
Seehofer, Daniel
Kaiser, Thorsten
author_facet Walter Costa, Maria Beatriz
Gärtner, Christiane
Schmidt, Maria
Berg, Thomas
Seehofer, Daniel
Kaiser, Thorsten
author_sort Walter Costa, Maria Beatriz
collection PubMed
description (1) Background: Prioritization of patients for liver transplantation in Germany relies on the MELD (model for end-stage liver disease) scoring system that does not consider the patient’s sex. Many studies have shown that women are disadvantaged by the MELD score. Using a large patient cohort from a German liver transplant centre, we investigated options to reduce gender inequality in the patient prioritization for liver transplantation. (2) Methods: We calculated female-as-male MELD scores in our cohort by substituting the serum creatinine of a female patient with that of their male equivalent to test for the fairness of the scores. We investigated the effects of the female-as-male scores compared to the original MELD score of 1759 patients listed for liver transplantation. (3) Results: Serum creatinine sex correction (female-as-male) for MELD scores added up to 5.4 points in females, while the median changed by +1.6 points for females. We identified 72 females with an original MELD score < 20, for whom the adjusted female-as-male MELD score would be >20, thus giving them a better chance to receive a liver transplant. (4) Conclusions: Mathematical conversion of female to male creatinine concentrations identified disadvantages in liver transplantation prioritization for females and ascertained MELD 3.0 as having high potential to compensate for these inequalities.
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spelling pubmed-103044092023-06-29 Revising the MELD Score to Address Sex-Bias in Liver Transplant Prioritization for a German Cohort Walter Costa, Maria Beatriz Gärtner, Christiane Schmidt, Maria Berg, Thomas Seehofer, Daniel Kaiser, Thorsten J Pers Med Brief Report (1) Background: Prioritization of patients for liver transplantation in Germany relies on the MELD (model for end-stage liver disease) scoring system that does not consider the patient’s sex. Many studies have shown that women are disadvantaged by the MELD score. Using a large patient cohort from a German liver transplant centre, we investigated options to reduce gender inequality in the patient prioritization for liver transplantation. (2) Methods: We calculated female-as-male MELD scores in our cohort by substituting the serum creatinine of a female patient with that of their male equivalent to test for the fairness of the scores. We investigated the effects of the female-as-male scores compared to the original MELD score of 1759 patients listed for liver transplantation. (3) Results: Serum creatinine sex correction (female-as-male) for MELD scores added up to 5.4 points in females, while the median changed by +1.6 points for females. We identified 72 females with an original MELD score < 20, for whom the adjusted female-as-male MELD score would be >20, thus giving them a better chance to receive a liver transplant. (4) Conclusions: Mathematical conversion of female to male creatinine concentrations identified disadvantages in liver transplantation prioritization for females and ascertained MELD 3.0 as having high potential to compensate for these inequalities. MDPI 2023-06-07 /pmc/articles/PMC10304409/ /pubmed/37373952 http://dx.doi.org/10.3390/jpm13060963 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Brief Report
Walter Costa, Maria Beatriz
Gärtner, Christiane
Schmidt, Maria
Berg, Thomas
Seehofer, Daniel
Kaiser, Thorsten
Revising the MELD Score to Address Sex-Bias in Liver Transplant Prioritization for a German Cohort
title Revising the MELD Score to Address Sex-Bias in Liver Transplant Prioritization for a German Cohort
title_full Revising the MELD Score to Address Sex-Bias in Liver Transplant Prioritization for a German Cohort
title_fullStr Revising the MELD Score to Address Sex-Bias in Liver Transplant Prioritization for a German Cohort
title_full_unstemmed Revising the MELD Score to Address Sex-Bias in Liver Transplant Prioritization for a German Cohort
title_short Revising the MELD Score to Address Sex-Bias in Liver Transplant Prioritization for a German Cohort
title_sort revising the meld score to address sex-bias in liver transplant prioritization for a german cohort
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304409/
https://www.ncbi.nlm.nih.gov/pubmed/37373952
http://dx.doi.org/10.3390/jpm13060963
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