title: Impact of creatinine values on MELD scores in male and female candidates for liver transplantation.
abstract: BACKGROUND
  A systematic bias against women, resulting from the use of creatinine as a measure of renal function, has been identified in Model for End-stage Liver Disease (MELD)-based liver allocation. Correction of this bias by calculation of female creatinine levels using the Modification of Diet in Renal Disease (MDRD) formula has been suggested.
  
  
  METHODS
  A cohort of 639 cirrhotic candidates for first-time liver transplantation was studied. Creatinine levels were corrected for gender using the MDRD formula. The accuracy of MELD, with or without creatinine correction, to predict 3-and 6-month mortality after inclusion in a transplant waiting list was estimated.
  
  
  RESULTS
  Women exhibited significantly lower creatinine levels, glomerular filtration rate, and MELD scores than men. After creatinine correction, female MELD scores had a mean increase of 1.1 points. Creatinine correction yielded an increase of 3 points in the MELD score in 15.2% of patients, 2 points in 22.4%, and 1 point in 17.6% of patients. The likelihood of death at 3 and 6 months after enrollment in the transplant waiting list was similar in males and females and the likelihood of receiving a transplant, as assessed by Kaplan-Meier survival curves, was also similar in males and females.
  
  
  CONCLUSIONS
  The survival or the likelihood of receiving a transplant while on the waiting list were similar in men and women in both pre- and post-MELD eras and creatinine correction did not increase the accuracy of the MELD score in estimating 3- and 6-month mortality in female candidates for liver transplantation.
authors.affiliation: Post Graduate Program in Medicine-Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil. gmariante@hotmail.com
authors.forename: Guilherme
authors.initials: G
authors.lastname: Mariante-Neto
authors.forename: Caroline P
authors.initials: CP
authors.lastname: Marroni
authors.forename: Alfeude Medeiros
authors.initials: AM
authors.lastname: Fleck Junior
authors.forename: Cláudio Augusto
authors.initials: CA
authors.lastname: Marroni
authors.forename: Maria Lúcia
authors.initials: ML
authors.lastname: Zanotelli
authors.forename: Guido
authors.initials: G
authors.lastname: Cantisani
authors.forename: Ajácio B M
authors.initials: AB
authors.lastname: Brandão
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006305:Health Status Indicators; D054625:Healthcare Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D014850:Waiting Lists / Q000401:mortality
chemical_list: D015415:Biomarkers; D003404:Creatinine