番茄社区

SAN FRANCISCO -- African-Americans on liver transplant waitlists had higher mean Model for End Stage Liver Disease (MELD) scores than all other races and ethnicities, while whites had the lowest, according to a comprehensive national study reported here.

Biological MELD scores at time of waitlist registration averaged 17.4 for all patients, but blacks presented with a mean score of 21.03, reported Ann Robinson, MD, of Highland Hospital in Oakland, California, and colleagues.

"A higher MELD score means a higher 3-month mortality risk, meaning these patients are more sick than other races or ethnicities at time of waitlist referral," Robinson told 番茄社区.

Other groups of non-white patients also had higher-than-overall-average MELD scores at registration, with means of 19.20 for Hispanics and 19.07 for Asians, Robinson said at the annual Liver Meeting, sponsored by the American Association for the Study of Liver Diseases.

MELD scores are based on laboratory data indicating how urgently they need a transplant. Patients are typically seen multiple times while on the liver transplant waitlist, and their scores may vary slightly throughout the process, depending on the status of their disease, according to the (UNOS).

Jordan Feld, MD, of the Toronto Western Hospital Liver Center, said the difference in MELD scores observed in this study was noteworthy and that a 4- or 5-point difference could amount to a significant amount of time on the waitlist. "That can be the difference between getting an organ and not getting an organ," he told 番茄社区.

Robinson and colleagues collected data from the UNOS liver transplant lists from 2005 to 2016 and compared race- and ethnicity-specific MELD scores at the time of a patient's registration to the waitlist and at time of transplant. They adjusted for age, sex, year, liver disease etiology, body mass index, ascites, and hepatic encephalopathy in their analysis.

Overall, data was collected from 88,542 liver transplant waitlist registrants, of which the majority were male (69.6%) and white (73.2%). Hepatitis C was the largest etiological category (41.3%), followed by alcoholic liver disease (25.3%), and nonalcoholic steatohepatitis (22.3%), Robinson reported. Just over 20% had hepatocellular carcinoma.

The racial-ethnic associations persisted after stratifying data by year and UNOS region, suggesting the disparities did not reflect geographic difference, as hypothesized in previous studies.

Robinson said that since UNOS regions are not homogenous in terms of waitlist transplant referral time and racial or ethnic composition, it's particularly important to control for geography and that racial disparities persisted in each region surveyed. She also noted that biological MELD scores do not take into account "exception points" for hepatocellular carcinoma and other diseases and may be lower than standard MELD scores.

David Mulligan, MD, of the Yale School of Medicine, said that before MELD was created in 2002, many patients who had low chances of mortality were receiving liver transplants often at the expense of sicker patients who had received late referrals. He emphasized that, with an objective system now in place, disparities occur in executing the organ delivery process, which could be affected by patients' distrust in the medical field, provider bias, or larger systemic problems such as the failure to develop specific outreach programs that could demystify the process for patients.

"The next stage is a healthcare delivery problem," he told 番茄社区. "How do you get better healthcare to people who don't want to go to the doctor or won't go until they're really sick? And how do you get their comorbidities managed more effectively so that when they do get referred, they can get put on the list as active and get a transplant?"

Robinson emphasized that stating African-Americans face significant "delays" in receiving transplants risks oversimplifying a complex system of liver allocation. She called for additional center-based studies that take a more granular look at the barriers to timely referral.

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