ArticleAmerican journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons2021
Correcting the sex disparity in MELD-Na.
Article in American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Serum chloride concentrations and outcomes in adult patients with cirrhosis: a systematic review and meta-analysis.BMC nephrology · 2025Pooled it
- Inconsistent values and algorithmic fairness: a review of organ allocation priority systems in the United States.BMC medical ethics · 2024Pooled it
- Addressing gender-based disparities in liver transplantation: A global analysis of surgical access and donor organ allocation.World journal of transplantation · 2026Article
- Sex and body size disparities under MELD 3.0: Evaluation of persisting gaps in liver transplant access.Hepatology (Baltimore, Md.) · 2026Article
- Peak-MELD scores, a disease trajectory associated with reduced access to liver transplantation.Frontiers in medicine · 2026Article
- Preliminary experience of combined dual plasma molecular adsorption system and plasma exchange in pediatric acute liver failure: a retrospective case series.BMC pediatrics · 2025Article
- Explainable machine learning for prognostic modeling of waitlist mortality in cirrhotic liver transplantation.Computational and structural biotechnology journal · 2025Article
- Article
- Construction of a novel prognostic scoring model for HBV-ACLF liver failure based on dynamic data.Scientific reports · 2024Article
- Sex differences in chronic liver disease and benign liver lesions.JHEP reports : innovation in hepatology · 2023Review
- Revising the MELD Score to Address Sex-Bias in Liver Transplant Prioritization for a German Cohort.Journal of personalized medicine · 2023Article
- Women with cirrhosis have lower self-rated health than men.Hepatology communications · 2023Article
- Proposing a Sex-Adjusted Sodium-Adjusted MELD Score for Liver Transplant Allocation.JAMA surgery · 2022Article
- 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.Transplantation direct · 2022Article
- "Beyond MELD" - Emerging strategies and technologies for improving mortality prediction, organ allocation and outcomes in liver transplantation.Journal of hepatology · 2022Review
- Building a Utility-based Liver Allocation Model in Preparation for Continuous Distribution.Transplantation direct · 2022Article
- Life expectancy without a transplant for status 1A liver transplant candidates.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2022Article
- Sex Disparity in Transplant: A Problem Hiding in Plain Sight.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2021Article
- Correcting the sex disparity in access to liver transplantation: Lest perfect be the enemy of better.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2021Article
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Abstract
MELD-Na appears to disadvantage women awaiting liver transplant by underestimating their mortality rate. Fixing this problem involves: (1) estimating the magnitude of this disadvantage separately for each MELD-Na, (2) designing a correction for each MELD-Na, and (3) evaluating corrections to MELD-Na using simulated allocation. Using Kaplan-Meier modeling, we calculated 90-day without-transplant survival for men and women, separately at each MELD-Na. For most scores between 15 and 35, without-transplant survival was higher for men by 0-5 percentage points. We tested two proposed corrections to MELD-Na (MELD-Na-MDRD and MELD-GRAIL-Na), and one correction we developed (MELD-Na-Shift) to target the differences we quantified in survival across the MELD-Na spectrum. In terms of without-transplant survival, MELD-Na-MDRD overcorrected sex differences while MELD-GRAIL-Na and MELD-Na-Shift eliminated them. Estimating the impact of implementing these corrections with the liver simulated allocation model, we found that MELD-Na-Shift alone eliminated sex disparity in transplant rates (p = 0.4044) and mortality rates (p = 0.7070); transplant rates and mortality rates were overcorrected by MELD-Na-MDRD (p = 0.0025, p = 0.0006) and MELD-GRAIL-Na (p = 0.0079, p = 0.0005). We designed a corrected MELD-Na that eliminates sex disparities in without-transplant survival, but allocation changes directing smaller livers to shorter candidates may also be needed to equalize women's access to liver transplant.
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