However, the adoption of Share 35 has potentially resulted in discrepancies in waitlist dropout for patients with sharp MELD increases at higher MELD scores. After the change to MELD-Na, increased dropout associated with ΔMELD 30 jumps is no longer evident at MELD scores below 30. Predictive accuracy was evaluated using the C-index for model discrimination and by comparing observed and predicted waitlist dropout probabilities for model calibration. Two composite scores were constructed and then evaluated on UNOS data spanning the current policy era ( to ). Current MELD and ΔMELD 30 were evaluated using cause-specific hazards models for waitlist dropout based on US liver transplant registrants added to the waitlist between and. We explored the potential of a registrant’s change in 30-day MELD scores (ΔMELD 30) to improve allocation both before and after these policy changes. The United Network for Organ Sharing (UNOS)/Organ Procurement Transplantation Network (OPTN) allocation policy has evolved over the years, and notable recent changes include Share 35, inclusion of serum sodium in the MELD score, and a ‘delay and cap’ policy for hepatocellular carcinoma (HCC) patients. Finally, the effects of the MELDNa score on race or genetic ancestry were not assessed.The Model for End-Stage Liver Disease (MELD) score has been successfully used to prioritize patients on the United States liver transplant waiting list since its adoption in 2002. Also, because lab tests were not uniformly ordered, diagnostic bias could have affected the sample. Study limitations included the fact that listing and delisting dates were unavailable. Individuals with liver cancer or on dialysis were excluded. Across the entire cohort, the median age was 44 years and 57.7% were women. Most of the participants were healthy controls (n=598,409), while 601 were liver transplant patients and 24,921 had chronic liver disease but did not undergo transplant. Replication analyses were performed at the multisite NIH All of Us Research Program. "Previous studies ascribed sex differences in MELDNa scores to known sex differences in creatinine levels, but creatinine does not fully account for the sex difference in MELDNa scores," wrote Davis and colleagues.įor their study, the researchers examined EHR data on 623,931 individuals who received care at the Vanderbilt University Medical Center (VUMC) from March 2019 to April 2020. The simulated sex-adjusted model also showed a moderate reduction in deaths at 1 year compared to the OPTN model (2,480 vs 2,493), which "suggested that the sex-adjusted scores could help save lives," the researchers noted. In a proposed, sex-adjusted MELDNa scoring allocation model, slightly more women would have received a liver transplant than men (24.1% vs 23.1%) under the Organ Procurement and Transplantation Network (OPTN) MELDNa scoring, more men received transplants (23.7% vs 23.0%). "All laboratory traits used in the calculation of MELDNa scores show sex differences that increase male individuals' scores compared with female individuals', despite female individuals showing greater liver decompensation," the group concluded. Women who underwent liver transplants had more decompensation traits (mean 1.60 vs 1.34), even though they had lower MELDNa scores before transplantation (mean 20.21 vs 21.72, P=0.005 for both). And the pattern persisted regardless of whether patients were undergoing a liver transplant, had liver disease without undergoing transplant, or were healthy, according to Lea Davis, PhD, of the Vanderbilt Genetics Institute in Nashville, Tennessee, and colleagues, writing in JAMA Surgery.
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