Study Seeks to Improve Gender Equity for Liver Transplantation Waiting List

Women who need a liver transplant are more likely to spend more time on a waiting list, become too sick for transplant or die compared to men. To improve equity, a recently published Vanderbilt-led study suggests a sex adjustment to criteria for MELD (model for end-stage liver disease), which determines allocation of transplanted livers.

The paper, “Proposing a Sex-Adjusted Sodium-Adjusted MELD Score for Liver Transplant Allocation” appears in JAMA Surgery.

To better determine at what point the sex disparity first appears, researchers probed the four lab measurements that the United Network for Organ Sharing (UNOS) uses to determine a transplant candidate’s priority on the waiting list for a donor liver — creatinine, international normalized ratio of prothrombin rate (INR), bilirubin and sodium. Looking at VUMC electronic medical records dating to 1990, researchers studied 623,931 patients.

“Instead of just looking at people who are already on the transplant list, or even people who already have liver disease, we went all the way back to people who are healthy without any liver disease, and we asked, at what point do we start to see these differences between males and females in these labs?” said Lea Davis, PhD, associate professor of Biomedical Informatics, an author of the study. “What we found was that even from the very beginning, prior to any liver disease, females on average have lower values on these labs than males do, and so when they start using these labs to determine the position on the waitlist, it’s as if males have a head start in relation to females.”

Read more in the VUMC Reporter here.