Evidence map›Paper›PMID 39944216›Full record

ArticleTransplant international : official journal of the European Society for Organ Transplantation2025

Systematic Sex-Based Inequity in the MELD Score-Based Allocation System for Liver Transplantation in Germany.

Leke Wiering, Annette Aigner, Marieke van Rosmalen, Brigitta Globke, Tomasz Dziodzio, Nathanael Raschzok, Münevver Demir, Wenzel Schöning, Frank Tacke, Petra Reinke and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Transplant international : official journal of the European Society for Organ Transplantation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. The Sex of Donor and Recipients in Solid Organ Transplantation: An in Depth Analysis Across the Council of Europe Member States.Transplant international : official journal of the European Society for Organ Transplantation · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Leke WieringCharité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Charité Campus Mitte, Berlin, Germany.
Annette AignerCharité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.
Marieke van RosmalenEurotransplant International Foundation, Leiden, Netherlands.
Brigitta GlobkeBerlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, Germany.
Tomasz DziodzioCharité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany.
Nathanael RaschzokBerlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, Germany.
Münevver DemirCharité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Charité Campus Mitte, Berlin, Germany.
Wenzel SchöningCharité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany.
Frank TackeCharité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Charité Campus Mitte, Berlin, Germany.
Petra ReinkeCharité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Center for Advanced Therapies (BeCAT), Berlin, Germany.
Johann PratschkeCharité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany.
Robert Öllinger *Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany.
Paul V Ritschl *Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

In liver allocation systems based on the Model for End-stage Liver Disease (MELD) score, sex inequities have been identified in countries with high organ donation rates. Whether similar inequities exist in regions with average to low donation rates remained unclear. We assessed the impact of sex on transplantation rates, waiting list mortality and post-transplant survival in 25,943 patients waitlisted for liver transplantation in Germany between 2003 and 2017 using competing risk analysis. Women are currently underrepresented on the waiting list (33.3%) and among transplant recipients (31.1%) compared to their proportion of severe liver disease cases (35.1%). The introduction of MELD-based allocation has worsened this disadvantage [HR before: 0.89 (0.81-0.98), after: 0.77 (0.74-0.81)]. Three key factors contribute to this disparity: Women have lower creatinine levels despite worse renal function, reducing their MELD score (median 1, 0-3). Second, exceptional MELD points are more frequently granted to men [HR 1.61 (1.54-1.69) compared to regular allocation]. Third, the small height of women has the highest impact on the probability of not being transplanted [adjusted HR 0.85 (0.81-0.9)]. Even in countries with lower organ donation rates, MELD-based allocation leads to sex inequity. Measures are needed to ensure sex-neutral liver allocation in MELD-based systems worldwide.

Indexed as

End Stage Liver DiseaseHealthcare DisparitiesLiver TransplantationTissue and Organ ProcurementAdultFemaleGermanyHumansMaleMiddle AgedSeverity of Illness IndexSex FactorsTissue DonorsWaiting Listsaccess to transplantationdisparitiesend stage liver diseasegendermodel for end-stage liver diseaseorgan procurement and allocationsex inequitywaiting list

Identifiers

PMID39944216
PMCPMC11813689

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.