title: Height contributes to the gender difference in wait-list mortality under the MELD-based liver allocation system.
abstract: This study examined factors associated with the gender disparity in wait-list mortality in the MELD era. Adult patients listed for liver transplantation from 2002 to 2008 were included. Females [12 585(36%)] and males [22 126(64%)] differed clinically by age (54 vs. 52 years), height (1.6 vs. 1.8 m), listing estimated glomerular filtration rate [(eGFR); 70 vs. 83 mL/min] and cirrhosis etiology. Holding MELD constant, females were at 19% (95% CI, 1.13-1.25, p < 0.001) higher risk of wait-list mortality than males under the current allocation system. The relative hazard increased with worsening renal function, whether measured by serum creatinine or eGFR. Adjustment for MELD, age, African-American race, cirrhosis etiology, region and ABO group attenuated this relative hazard (HR 1.16; 95% CI, 1.10-1.22; p < 0.001) but additional adjustment for height completely explained this gender disparity in wait-list mortality (HR 1.05; 95% CI, 0.98-1.12; p = 0.2). Transplantation rates, however, remained lower among females, even after adjustment for height (HR 0.88; 95% CI, 0.82-0.92; p < 0.001). In conclusion, under the current liver allocation system, women have a 19% increased risk of wait-list mortality compared to men with the same MELD scores. Height contributes to this gender disparity, possibly reflecting differences in transplantation rates for shorter individuals.
authors.affiliation: Division of Gastroenterology and Hepatology, University of California, San Francisco, CA, USA. jennifer.lai@ucsf.edu
authors.forename: J C
authors.initials: JC
authors.lastname: Lai
authors.forename: N A
authors.initials: NA
authors.lastname: Terrault
authors.forename: E
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: S W
authors.initials: SW
authors.lastname: Biggins
mesh_terms: D000328:Adult; D001827:Body Height; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014850:Waiting Lists / Q000401:mortality*