Gender disparity and MELD in liver transplantation

Abstract

range 50-96.5 IU/L and, in only 4 out of 138 patients (2.9%), levels above 200 IU/L (that is, five times above upper limit of normal) were found (maximal value, 294). AST/ALT ratios in these 4 patients were 0.61, 0.52, 0.78 and 0.55, similar to the whole group of patients. Thus, we might suggest that most of the patients were not showing a drug-induced liver injury able to modify AST or ALT levels. The AST/ALT ratio is a very important variable, strongly associated with the presence of advanced fibrosis in the univariate analysis (with higher odds ratio than other variables) and therefore, is included in both scoring systems, the NAFLD fibrosis score and the BARD score. Furthermore, in the BARD score, an AST/ALT ratio P0.8 sums 2 points while the other two variables, presence of diabetes or body mass index P28, sum only 1 point. However, the information on the list of medications taken by the patients is also lacking in the two original studies [1,2].

A Critical Review of MELD as a Reliable Tool for Transplant Prioritization

“…Thus, the normal serum creatinine threshold may vary in women or patients with a different baseline nutritional status. 16,17 In addition to the discussion on the MELD components currently in use, there are concerns about the simplicity of the score: the score may not be exhaustive with respect to mortality predictive factors. Some authors have tried to find additional new factors to include in MELD to improve its performance to prioritize patients on the waiting list and predict posttransplant mortality.…”

“…The main explanation is the lower serum creatinine level in women compared with men. 16,17 Second, it is possible that this gender disparity may be linked to a longer waiting on the list because of difficulties to match the donor organ size, since short stature is related to higher risk of death on the waitlist. 33…”

Model for End-Stage Liver Disease: End of the First Decade

“…57 As a function of less muscle mass, serum creatinine may underestimate the severity of renal dysfunction in women. Hence, an inaccurate representation of their renal dysfunction may disadvantage women with lower rates of LT and higher wait list mortality for women.…”

Correcting the sex disparity in MELD-Na

“…Women are more likely than men to die on the liver transplant waitlist, more likely to be removed from the waitlist for being “too sick” for transplant, and less likely to receive a transplant 1–6 . Some of these sex differences might stem from lower serum creatinine (and hence a lower model for end‐stage liver disease [MELD‐Na] score) for women versus men with similar renal dysfunction 1,3,5,7–12 . However, the contribution of creatinine to MELD‐Na varies across the score spectrum because creatinine measurements are rounded up to 1.0 and capped at 4.0 mg/dl, 13 so it is likely that sex differences also vary across the MELD‐Na score spectrum.…”

“…[1][2][3][4][5][6] Some of these sex differences might stem from lower serum creatinine (and hence a lower model for end-stage liver disease [MELD-Na] score) for women versus men with similar renal dysfunction. 1,3,5,[7][8][9][10][11][12] However, the contribution of creatinine to MELD-Na varies across the score spectrum because creatinine measurements are rounded up to 1.0 and capped at 4.0 mg/dl, 13 so it is likely that sex differences also vary across the MELD-Na score spectrum. While both Myers et al and Locke et al 5,14 have estimated the average difference (across all MELD-Na scores) between men and women in…”