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. 2010 Dec;10(12):2658-64.
doi: 10.1111/j.1600-6143.2010.03326.x. Epub 2010 Nov 18.

Height contributes to the gender difference in wait-list mortality under the MELD-based liver allocation system

J C Lai  1 , N A Terrault, E Vittinghoff, S W Biggins
Affiliations

Height contributes to the gender difference in wait-list mortality under the MELD-based liver allocation system

J C Lai et al. Am J Transplant. 2010 Dec.

Abstract

This study examined factors associated with the gender disparity in wait-list mortality in the MELD era. Adult patients listed for liver transplantation from 2002 to 2008 were included. Females [12 585(36%)] and males [22 126(64%)] differed clinically by age (54 vs. 52 years), height (1.6 vs. 1.8 m), listing estimated glomerular filtration rate [(eGFR); 70 vs. 83 mL/min] and cirrhosis etiology. Holding MELD constant, females were at 19% (95% CI, 1.13-1.25, p < 0.001) higher risk of wait-list mortality than males under the current allocation system. The relative hazard increased with worsening renal function, whether measured by serum creatinine or eGFR. Adjustment for MELD, age, African-American race, cirrhosis etiology, region and ABO group attenuated this relative hazard (HR 1.16; 95% CI, 1.10-1.22; p < 0.001) but additional adjustment for height completely explained this gender disparity in wait-list mortality (HR 1.05; 95% CI, 0.98-1.12; p = 0.2). Transplantation rates, however, remained lower among females, even after adjustment for height (HR 0.88; 95% CI, 0.82-0.92; p < 0.001). In conclusion, under the current liver allocation system, women have a 19% increased risk of wait-list mortality compared to men with the same MELD scores. Height contributes to this gender disparity, possibly reflecting differences in transplantation rates for shorter individuals.

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Figures

Figure 1
Figure 1
Flow of Patients Listed for Liver Transplantation. Abbreviations: HCC, hepatocellular carcinoma; FHF, fulminant hepatic failure; AHN, acute hepatic necrosis; Cr, serum creatinine at listing.
Figure 2
Figure 2
Cumulative incidence curves comparing the risk of wait -list mortality in females compared with males, adjusted for MELD only.
Figure 3
Figure 3
Adjusted Risk of Wait-list Mortality for Females Compared with Males.
Figure 4
Figure 4
Relative Hazard of Wait-List Mortality for Females Compared to Males By A) Creatinine at Listing (mg/dL) and B) GFR at Listing (ml/min).
Figure 5
Figure 5
Height of Female and Male Wait-List Candidates in the United States.
See this image and copyright information in PMC

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