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GEMA-Na and MELD 3.0 severity scores to address sex disparities for accessing liver transplantation: a nationwide retrospective cohort study

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dc.contributor.authorRodríguez-Perálvarez, Manuel
dc.contributor.authorRosa, Gloria de la
dc.contributor.authorGómez-Orellana, Antonio Manuel
dc.contributor.authorAguilera, María Victoria
dc.contributor.authorPascual Vicente, Teresa
dc.contributor.authorPereira, Sheila
dc.contributor.authorOrtiz, María Luisa
dc.contributor.authorPagano, Giulia
dc.contributor.authorSuarez, Francisco
dc.contributor.authorGonzález-Grande, Rocio
dc.contributor.authorCachero, Alba
dc.contributor.authorTomé, Santiago
dc.contributor.authorBarreales, Mónica
dc.contributor.authorMartin Mateos, Rosa
dc.contributor.authorPascual, Sonia
dc.contributor.authorRomero, Mario
dc.contributor.authorBilbao, Itxarone
dc.contributor.authorAlonso Martin, Carmen
dc.contributor.authorOtón, Elena
dc.contributor.authorGonzález-Diéguez, Luisa
dc.contributor.authorEspinosa, María Dolores
dc.contributor.authorArias Milla, Ana
dc.contributor.authorBlanco Fernández, Gerardo
dc.contributor.authorLorente, Sara
dc.contributor.authorCuadrado Lavín, Antonio
dc.contributor.authorRedín García, Amaya
dc.contributor.authorSánchez Cano, Clara
dc.contributor.authorCepeda-Franco, Carmen
dc.contributor.authorPons Miñano, José Antonio
dc.contributor.authorColmenero, Jordi
dc.contributor.authorGuijo-Rubio, David
dc.contributor.authorOtero, Alejandra
dc.contributor.authorAmador Navarrete, Alberto
dc.contributor.authorRomero Romero, Sarai
dc.contributor.authorRodríguez Soler, María
dc.contributor.authorHervás Martínez, Cesar
dc.contributor.authorGataca, Mikel
dc.contributor.departmentMedicina
dc.date.accessioned2025-01-26T11:17:01Z
dc.date.available2025-01-26T11:17:01Z
dc.date.issued2024-07-18
dc.description© 2024 The Author(s). This manuscript version is made available under the CC-BY 4.0 license http://creativecommons.org/licenses/by/4.0/. This document is the Published version of a Published Work that appeared in final form in EClinicalMedicine. To access the final edited and published work see https://doi.org/10.1016/j.eclinm.2024.102737
dc.description.abstractBackground The Gender-Equity Model for liver Allocation corrected by serum sodium (GEMA-Na) and the Model for End-stage Liver Disease 3.0 (MELD 3.0) could amend sex disparities for accessing liver transplantation (LT). We aimed to assess these inequities in Spain and to compare the performance of GEMA-Na and MELD 3.0. Methods Nationwide cohort study including adult patients listed for a first elective LT (January 2016–December 2021). The primary outcome was mortality or delisting for sickness within the first 90 days. Independent predictors of the primary outcome were evaluated using multivariate Cox’s regression with adjusted relative risks (RR) and 95% confidence intervals (95% CI). The discrimination of GEMA-Na and MELD 3.0was assessed using Harrell c-statistics (Hc). Findings The study included 6071 patients (4697 men and 1374 women). Mortality or delisting for clinical deterioration occurred in 286 patients at 90 days (4.7%). Women had reduced access to LT (83.7% vs. 85.9%; p = 0.037) and increased risk of mortality or delisting for sickness at 90 days (adjusted RR = 1.57 [95% CI 1.09–2.28]; p = 0.017). Female sex remained as an independent risk factor when using MELD or MELD-Na but lost its significance in the presence of GEMA-Na or MELD 3.0. Among patients included for reasons other than tumours (n = 3606; 59.4%), GEMA-Na had Hc = 0.753 (95% CI 0.715–0.792), which was higher than MELD 3.0 (Hc = 0.726 [95% CI 0.686–0.767; p = 0.001), showing both models adequate calibration. Interpretation GEMA-Na and MELD 3.0 might correct sex disparities for accessing LT, but GEMA-Na provides more accurate predictions of waiting list outcomes and could be considered the standard of care for waiting list prioritization.es
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dc.format.extent12es
dc.identifier.citationeClinicalMedicine 2024 74: 102737
dc.identifier.doihttps://doi.org/10.1016/j.eclinm.2024.102737
dc.identifier.issnelectronic: 2589-5370
dc.identifier.urihttp://hdl.handle.net/10201/149317
dc.languageenges
dc.publisherElsevieres
dc.relationThe present study was supported by the Spanish Ministry of Research and Innovation, the “Instituto de Salud Carlos III” (grant reference PI22/ 00312), the “Agencia Estatal de Investigación (España)” (grant reference: PID2020-115454GB-C22/AEI/10.13039/501100011033), and co-funded by the European Union. AMG-O was supported by “Consejería de Transformación Económica, Industria, Conocimiento y Universidades de la Junta de Andalucía” (grant reference: PREDOC-00489). DG-R was supported by the “Agencia Estatal de Investigación (España)” and European Union NextGenerationEU/PRTR (grant ref.: JDC2022-048378-I).es
dc.relation.publisherversionhttps://www.sciencedirect.com/science/article/pii/S258953702400316X?via%3Dihub
dc.rightsinfo:eu-repo/semantics/openAccesses
dc.rightsAtribución 4.0 Internacional*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectSexes
dc.subjectEquity
dc.subjectLiver transplantation
dc.subjectUrgency
dc.subjectAllocation
dc.titleGEMA-Na and MELD 3.0 severity scores to address sex disparities for accessing liver transplantation: a nationwide retrospective cohort studyes
dc.typeinfo:eu-repo/semantics/articlees
dspace.entity.typePublicationes
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