Correcting the sex disparity in MELD-Na

Wood, Nicholas L.; VanDerwerken, Douglas; Segev, Dorry L.; Gentry, Sommer E.

doi:10.1111/ajt.16731

Cited by 32 publications

(35 citation statements)

References 28 publications

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“…Recently, Woods et al assessed gender-based differences in mortality prediction scores including GRAIL in a larger cohort from the Scientific Registry of Transplant Recipients; however, they did not specifically address discrimination or calibration. 16 Our study cohort spans from January 1998 to July 2019. During this period, there have been some significant changes in LT WL management in Australia.…”

Section: Discussionmentioning

confidence: 99%

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MELD-GRAIL and MELD-GRAIL-Na Are Not Superior to MELD or MELD-Na in Predicting Liver Transplant Waiting List Mortality at a Single-center Level

Chetwood

Wells

Tsoutsman

et al. 2022

Transplantation Direct

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Background. Controversy exists regarding the best predictive model of liver transplant waiting list (WL) mortality. Models for end-stage liver disease–glomerular filtration rate assessment in liver disease (MELD-GRAIL) and MELD-GRAIL-Na were recently described to provide better prognostication, particularly in females. We evaluated the performance of these scores compared to MELD and MELD-Na. Methods. Consecutive patients with cirrhosis waitlisted for liver transplant from 1998 to 2017 were examined in this single-center study. The primary outcome was 90-d WL mortality. MELD, MELD-Na, MELD-GRAIL, and MELD-GRAIL-Na at the time of WL registration were compared. Model discrimination was assessed with area under the receiver operating characteristic curves and Harrell’s C-index after fitting Cox models. Model calibration was examined with Grønnesby and Borgan’s modification of the Hosmer-Lemeshow formula and by comparing predicted/observed outcomes across model strata. Results. The study population comprised 1108 patients with a median age of 53.5 (interquartile range 48–59) y and male predominance (74.9%). All models had excellent areas under the receiver operating characteristic curves for the primary outcome (MELD 0.89, MELD-Na 0.91, MELD-GRAIL 0.89, MELD-GRAIL-Na 0.89; all comparisons P > 0.05). Youden index cutoffs for 90-d mortality were as follows: MELD, 19; MELD-Na, 22; MELD-GRAIL, 18; and MELD-GRAIL-Na, 17. Variables associated with 90-d mortality on multivariable Cox regression were sodium, bilirubin, creatinine, and international normalized ratio. There were no differences in model discrimination using Harrell’s C-index. All models were well calibrated; however, divergence between observed and predicted mortality was noted with scores ≥25. Conclusion. There were no demonstrable differences in discrimination or calibration of GRAIL-based models compared with MELD or MELD-Na in our cohort. This suggests that GRAIL-based models may not have meaningful improvements in discriminatory ability when applied to other settings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

MELD-GRAIL and MELD-GRAIL-Na Are Not Superior to MELD or MELD-Na in Predicting Liver Transplant Waiting List Mortality at a Single-center Level

Chetwood

Wells

Tsoutsman

et al. 2022

Transplantation Direct

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“…In this issue of AJT, Wood et al compare four scores to determine waitlist priority-the existing MELD-Na, the previously proposed MELD-Na-MDRD and MELD-Na-GRAIL, and a new MELD-Na-Shift-and consider their effect on waitlist outcomes and transplant rates. 4 The authors apply robust statistical methods in a data set…”

Section: Correcting the Sex Disparity In Access To Liver Transplantation: Lest Perfect Be The Enemy Of Bettermentioning

confidence: 99%

“…1-3 Alternative models have been proposed to reduce this gap, including replacement of serum creatinine with estimated glomerular filtration rate or granting additional MELD points to women, but what has been lacking in the literature has been quantification and comparison of the potential impact of these models on the sex disparity itself.In this issue of AJT, Wood et al compare four scores to determine waitlist priority-the existing MELD-Na, the previously proposed MELD-Na-MDRD and MELD-Na-GRAIL, and a new MELD-Na-Shift-and consider their effect on waitlist outcomes and transplant rates. 4 The authors apply robust statistical methods in a data set…”

mentioning

confidence: 99%

Correcting the sex disparity in access to liver transplantation: Lest perfect be the enemy of better

Kwong

Lai

Kim

2021

American Journal of Transplantation

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Correcting the sex disparity in access to liver transplantation: Lest perfect be the enemy of betterThe implementation of the model for end-stage liver disease (MELD) as the backbone of liver allocation policy in the United States in 2002 has overall improved waitlist outcomes and standardized access to liver transplantation for patients with end-stage liver disease.However, women experience higher waitlist mortality and lower transplant rates compared with men, attributed in part to underestimation of renal dysfunction by the use of serum creatinine in MELD and MELD-Na. 1-3 Alternative models have been proposed to reduce this gap, including replacement of serum creatinine with estimated glomerular filtration rate or granting additional MELD points to women, but what has been lacking in the literature has been quantification and comparison of the potential impact of these models on the sex disparity itself.In this issue of AJT, Wood et al. compare four scores to determine waitlist priority-the existing MELD-Na, the previously proposed MELD-Na-MDRD and MELD-Na-GRAIL, and a new MELD-Na-Shift-and consider their effect on waitlist outcomes and transplant rates. 4 The authors apply robust statistical methods in a data set

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“… 2 It has undergone modifications over the years 3 —notably MELD sodium (MELD-Na) in 2016 4 —and will perhaps be revised in the future—with new propositions including MELD 3.0 5 and MELD-Na-Shift. 6 All of these models are based on the prioritization of medical urgency, which has remained unchanged for almost 2 decades. However, MELD is a poor predictor of posttransplant outcomes.…”

Section: Introductionmentioning

confidence: 99%

Building a Utility-based Liver Allocation Model in Preparation for Continuous Distribution

Kling

Perkins

Biggins

et al. 2022

Transplantation Direct

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Background. The current model for end-stage liver disease-based liver allocation system in the United States prioritizes sickest patients first at the expense of long-term graft survival. In a continuous distribution model, a measure of posttransplant survival will also be included. We aimed to use mathematical optimization to match donors and recipients based on quality to examine the potential impact of an allocation system designed to maximize long-term graft survival. Methods. Cox proportional hazard models using organ procurement and transplantation network data from 2008 to 2012 were used to place donors and waitlist candidates into 5 groups of increasing risk for graft loss (1—lowest to 5—highest). A mixed integer programming optimization model was then used to generate allocation rules that maximized graft survival at 5 and 8 y. Results. Allocation based on mathematical optimization improved 5-y survival by 7.5% (78.2% versus 70.7% in historic cohort) avoiding 2271 graft losses, and 8-y survival by 9% (71.8% versus 62.8%) avoiding 2725 graft losses. Long-term graft survival for recipients within a quality group is highly dependent on donor quality. All candidates in groups 1 and 2 and 43% of group 3 were transplanted, whereas none of the candidates in groups 4 and 5 were transplanted. Conclusions. Long-term graft survival can be improved using a model that allocates livers based on both donor and recipient quality, and the interaction between donor and recipient quality is an important predictor of graft survival. Considerations for incorporation into a continuous distribution model are discussed.

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Correcting the sex disparity in MELD-Na

Cited by 32 publications

References 28 publications

MELD-GRAIL and MELD-GRAIL-Na Are Not Superior to MELD or MELD-Na in Predicting Liver Transplant Waiting List Mortality at a Single-center Level

MELD-GRAIL and MELD-GRAIL-Na Are Not Superior to MELD or MELD-Na in Predicting Liver Transplant Waiting List Mortality at a Single-center Level

Correcting the sex disparity in access to liver transplantation: Lest perfect be the enemy of better

Building a Utility-based Liver Allocation Model in Preparation for Continuous Distribution

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