ArticleEClinicalMedicine2024
GEMA-Na and MELD 3.0 severity scores to address sex disparities for accessing liver transplantation: a nationwide retrospective cohort study.
Article in EClinicalMedicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Addressing gender-based disparities in liver transplantation: A global analysis of surgical access and donor organ allocation.World journal of transplantation · 2026Article
- Excluding Ascites From the GEMA-Na Score Does Not Impact Outcome Predictions in Liver Transplant Candidates.Liver international : official journal of the International Association for the Study of the Liver · 2026Observational
- MELD 3.0 score in prediction of varices and comparison with its previous versions in patients undergoing esophago-gastro-duodenoscopy for variceal screening or band ligation.Pakistan journal of medical sciences · 2025Article
- Review
- Improved Discrimination and Predictive Ability of Novel Prognostic Scores for Long-term Mortality in Hospitalized Patients with Cirrhosis.Journal of clinical and translational hepatology · 2025Article
- Sina Score as a New Machine Learning-Derived Online Prediction Model of Mortality for Cirrhotic Patients Awaiting Liver Transplantation: A Prospective Cohort Study.Journal of clinical medicine · 2025Article
- Sex-based disparities in liver transplantation: Evidence from a nationwide Italian cohort.JHEP reports : innovation in hepatology · 2025Article
- Preliminary experience of combined dual plasma molecular adsorption system and plasma exchange in pediatric acute liver failure: a retrospective case series.BMC pediatrics · 2025Article
- Validation of gender-equity model for liver allocation (GEMA) and its sodium variant (GEMA-Na) in candidates for liver transplantation.Annals of gastroenterologyArticle
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Authors and funding
37 authors.
Funding
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Abstract
Background: The Gender-Equity Model for liver Allocation corrected by serum sodium (GEMA-Na) and the Model for End-stage Liver Disease 3.0 (MELD 3.0) could amend sex disparities for accessing liver transplantation (LT). We aimed to assess these inequities in Spain and to compare the performance of GEMA-Na and MELD 3.0. Methods: Nationwide cohort study including adult patients listed for a first elective LT (January 2016-December 2021). The primary outcome was mortality or delisting for sickness within the first 90 days. Independent predictors of the primary outcome were evaluated using multivariate Cox's regression with adjusted relative risks (RR) and 95% confidence intervals (95% CI). The discrimination of GEMA-Na and MELD 3.0was assessed using Harrell c-statistics (Hc). Findings: The study included 6071 patients (4697 men and 1374 women). Mortality or delisting for clinical deterioration occurred in 286 patients at 90 days (4.7%). Women had reduced access to LT (83.7% vs. 85.9%; p = 0.037) and increased risk of mortality or delisting for sickness at 90 days (adjusted RR = 1.57 [95% CI 1.09-2.28]; p = 0.017). Female sex remained as an independent risk factor when using MELD or MELD-Na but lost its significance in the presence of GEMA-Na or MELD 3.0. Among patients included for reasons other than tumours (n = 3606; 59.4%), GEMA-Na had Hc = 0.753 (95% CI 0.715-0.792), which was higher than MELD 3.0 (Hc = 0.726 [95% CI 0.686-0.767; p = 0.001), showing both models adequate calibration. Interpretation: GEMA-Na and MELD 3.0 might correct sex disparities for accessing LT, but GEMA-Na provides more accurate predictions of waiting list outcomes and could be considered the standard of care for waiting list prioritization. Funding: Instituto de Salud Carlos III, Agencia Estatal de Investigación (Spain), and European Union.
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