番茄社区

Women with access to a potential living donor (pLD) had a similar shot as men at getting a liver transplant, a retrospective study from Canada found.

Without a pLD, women on the liver transplant list were significantly less likely to receive a transplant (HR 1.29, 95% CI 1.04-1.60, P=0.01), but there was no difference when availability of a pLD existed (HR 0.93, 95% CI 0.76-1.14, P=0.44), Mamatha Bhat, MD, PhD, of the University Health Network in Toronto, and colleagues reported.

Women who qualified for a deceased donor organ had higher Model for End-stage Liver Disease incorporating sodium levels (MELD-Na) scores versus men, "meaning that they had to be much sicker to have access to transplant," the group wrote in .

In those without a pLD, MELD-Na scores were significantly higher for women both at listing (22 vs 19 in men) and at transplant (27 vs 20, respectively; P<0.001 for both).

Liver transplant waiting lists allocate organs based on MELD scoring, which improves equity while prioritizing critically ill patients. Despite this, women remain less likely to receive deceased-donor livers, the authors noted, with men twice as likely to receive transplants.

"Since multiple factors contribute to this disparity, we need to develop better policies to ensure more equitable access to organs," Bhat and coauthors concluded. "Our findings suggest that in this era of MELD-based allocation, living donor liver transplant can help in bridging the sex-based disparity in liver transplant and hence should be particularly encouraged among women."

For their study, the researchers evaluated 1,289 adults who were on the liver transplant waiting list for decompensated cirrhosis at the University Health Network in Canada from November 2012 to May 2019.

Average patient age was 56 years, 64% were men (n=830; 270 with a pLD) and 36% were women (n=459; 219 with a pLD). Mean MELD-Na score was 20.3 at listing, 22% of patients had alcoholic liver disease, 22% had hepatitis C, and 16% had nonalcoholic fatty liver disease.

Women with access to a pLD had an instantaneous rate of liver transplant nearly twice as high as women without a pLD (HR 1.92, 95% CI 1.51-2.44), while men with a pLD had a rate 1.39 times higher than those without (HR 1.39, 95% CI 1.18-1.65).

MELD-Na scores of 25 or higher at listing led to earlier and better chances of receiving a transplant (P<0.001 for both):

• Men: HR 1.73 (95% CI 1.39-2.17)
• Women: HR 1.82 (95% CI 1.39-2.39)

Adjusted multivariable survival analysis showed that in women without a pLD, taller women had greater chances of receiving a liver than shorter women (HR 1.04, 95% CI 1.01-1.07, P=0.01), in line with previous findings.

At 1 year, 55.7% of patients received a liver, 23.4% remained on the list, and 21.4% dropped out.

At study completion, 62% of men and 59% of women had received a transplant -- 44% of which were from deceased donors and 16% from living donors. In all, 90 patients remained on the waitlist (median waitlist time, 5 months). Among the 416 dropout patients, 15% were delisted and 17% died (19% women, 16% men).

Study limitations included leaving ascites unaccounted for in calculations and lacking sociodemographic data, which can affect access to deceased donor transplant, the authors acknowledged.

Comment