title: Model for End-Stage Liver Disease: Is Sex-Based Creatinine Correction a Viable Strategy for Black Females?
abstract: BACKGROUND
  The model for end-stage liver disease (MELD) is based on objective variables, including serum creatinine (SCr). This study assesses the influence of skin color on MELD scores calculated using SCr or corrected creatinine (CrC) in female candidates for liver transplantation (LTx).
  
  
  METHODS
  White and black women were eligible. The glomerular filtration rate (GFR) was calculated by means of the Modification of Diet in Renal Disease formula, using SCr. The GFR was then used for reverse calculation of CrC considering each female as male. The MELD scores were calculated using both creatinine values and compared between white and black candidates.
  
  
  RESULTS
  SCr-based and CrC-based scores were similar between groups. Calculated GFR was significantly higher in black women than in white women (P < 0.001). Use of CrC yielded 1-point, 2-point, and 3-point increases in the MELD score in 20.2%, 25.7%, and 17.5% of white patients, respectively. None of the black patients had a MELD score increase greater than 1 point. The CrC-based MELD calculation would benefit 63.4% of white females and only 26.1% of black females.
  
  
  CONCLUSIONS
  Use of CrC for MELD calculation would prioritize white females for liver allocation, but does not seem feasible, as it would not ensure equitable allocation across different ethnicities.
authors.affiliation: 1 Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil. 2 Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, RS, Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Mariante-Neto
authors.forename: Ajacio Bm
authors.initials: AB
authors.lastname: Brandão
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D044383:Black People; D001938:Brazil / Q000453:epidemiology; D003404:Creatinine / Q000097:blood*; D058625:End Stage Liver Disease / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005919:Glomerular Filtration Rate; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D016031:Liver Transplantation; D008875:Middle Aged; D008954:Models, Biological; D018579:Patient Selection; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D012737:Sex Factors; D012880:Skin Pigmentation; D014850:Waiting Lists; D044465:White People
chemical_list: D015415:Biomarkers; D003404:Creatinine