Systematic Sex-Based Inequity in the MELD Score-Based Allocation System for Liver Transplantation in Germany
In liver allocation systems based on the Model for End-stage Liver Disease (MELD) score, sex inequities have been identified in countries with high organ donation rates. Whether similar inequities exist in regions with average to low donation rates remained unclear. We assessed the impact of sex on...
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Frontiers Media S.A.
2025-01-01
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| Series: | Transplant International |
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| Online Access: | https://www.frontierspartnerships.org/articles/10.3389/ti.2025.13844/full |
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| author | Leke Wiering Leke Wiering Annette Aigner Marieke van Rosmalen Brigitta Globke Brigitta Globke Tomasz Dziodzio Nathanael Raschzok Nathanael Raschzok Münevver Demir Wenzel Schöning Frank Tacke Petra Reinke Johann Pratschke Robert Öllinger Paul V. Ritschl Paul V. Ritschl |
| author_facet | Leke Wiering Leke Wiering Annette Aigner Marieke van Rosmalen Brigitta Globke Brigitta Globke Tomasz Dziodzio Nathanael Raschzok Nathanael Raschzok Münevver Demir Wenzel Schöning Frank Tacke Petra Reinke Johann Pratschke Robert Öllinger Paul V. Ritschl Paul V. Ritschl |
| author_sort | Leke Wiering |
| collection | DOAJ |
| description | In liver allocation systems based on the Model for End-stage Liver Disease (MELD) score, sex inequities have been identified in countries with high organ donation rates. Whether similar inequities exist in regions with average to low donation rates remained unclear. We assessed the impact of sex on transplantation rates, waiting list mortality and post-transplant survival in 25,943 patients waitlisted for liver transplantation in Germany between 2003 and 2017 using competing risk analysis. Women are currently underrepresented on the waiting list (33.3%) and among transplant recipients (31.1%) compared to their proportion of severe liver disease cases (35.1%). The introduction of MELD-based allocation has worsened this disadvantage [HR before: 0.89 (0.81–0.98), after: 0.77 (0.74–0.81)]. Three key factors contribute to this disparity: Women have lower creatinine levels despite worse renal function, reducing their MELD score (median 1, 0–3). Second, exceptional MELD points are more frequently granted to men [HR 1.61 (1.54–1.69) compared to regular allocation]. Third, the small height of women has the highest impact on the probability of not being transplanted [adjusted HR 0.85 (0.81–0.9)]. Even in countries with lower organ donation rates, MELD-based allocation leads to sex inequity. Measures are needed to ensure sex-neutral liver allocation in MELD-based systems worldwide. |
| format | Article |
| id | doaj-art-74dcd6c886764f70868c878b18d626f0 |
| institution | Kabale University |
| issn | 1432-2277 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Transplant International |
| spelling | doaj-art-74dcd6c886764f70868c878b18d626f02025-01-29T04:11:09ZengFrontiers Media S.A.Transplant International1432-22772025-01-013810.3389/ti.2025.1384413844Systematic Sex-Based Inequity in the MELD Score-Based Allocation System for Liver Transplantation in GermanyLeke Wiering0Leke Wiering1Annette Aigner2Marieke van Rosmalen3Brigitta Globke4Brigitta Globke5Tomasz Dziodzio6Nathanael Raschzok7Nathanael Raschzok8Münevver Demir9Wenzel Schöning10Frank Tacke11Petra Reinke12Johann Pratschke13Robert Öllinger14Paul V. Ritschl15Paul V. Ritschl16Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Charité Campus Mitte, Berlin, GermanyBerlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, GermanyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, GermanyEurotransplant International Foundation, Leiden, NetherlandsBerlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, GermanyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, GermanyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, GermanyBerlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, GermanyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, GermanyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Charité Campus Mitte, Berlin, GermanyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, GermanyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Charité Campus Mitte, Berlin, GermanyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Center for Advanced Therapies (BeCAT), Berlin, GermanyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, GermanyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, GermanyBerlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, GermanyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, GermanyIn liver allocation systems based on the Model for End-stage Liver Disease (MELD) score, sex inequities have been identified in countries with high organ donation rates. Whether similar inequities exist in regions with average to low donation rates remained unclear. We assessed the impact of sex on transplantation rates, waiting list mortality and post-transplant survival in 25,943 patients waitlisted for liver transplantation in Germany between 2003 and 2017 using competing risk analysis. Women are currently underrepresented on the waiting list (33.3%) and among transplant recipients (31.1%) compared to their proportion of severe liver disease cases (35.1%). The introduction of MELD-based allocation has worsened this disadvantage [HR before: 0.89 (0.81–0.98), after: 0.77 (0.74–0.81)]. Three key factors contribute to this disparity: Women have lower creatinine levels despite worse renal function, reducing their MELD score (median 1, 0–3). Second, exceptional MELD points are more frequently granted to men [HR 1.61 (1.54–1.69) compared to regular allocation]. Third, the small height of women has the highest impact on the probability of not being transplanted [adjusted HR 0.85 (0.81–0.9)]. Even in countries with lower organ donation rates, MELD-based allocation leads to sex inequity. Measures are needed to ensure sex-neutral liver allocation in MELD-based systems worldwide.https://www.frontierspartnerships.org/articles/10.3389/ti.2025.13844/fullorgan procurement and allocationmodel for end-stage liver diseaseend stage liver diseasedisparitiesgendersex inequity |
| spellingShingle | Leke Wiering Leke Wiering Annette Aigner Marieke van Rosmalen Brigitta Globke Brigitta Globke Tomasz Dziodzio Nathanael Raschzok Nathanael Raschzok Münevver Demir Wenzel Schöning Frank Tacke Petra Reinke Johann Pratschke Robert Öllinger Paul V. Ritschl Paul V. Ritschl Systematic Sex-Based Inequity in the MELD Score-Based Allocation System for Liver Transplantation in Germany Transplant International organ procurement and allocation model for end-stage liver disease end stage liver disease disparities gender sex inequity |
| title | Systematic Sex-Based Inequity in the MELD Score-Based Allocation System for Liver Transplantation in Germany |
| title_full | Systematic Sex-Based Inequity in the MELD Score-Based Allocation System for Liver Transplantation in Germany |
| title_fullStr | Systematic Sex-Based Inequity in the MELD Score-Based Allocation System for Liver Transplantation in Germany |
| title_full_unstemmed | Systematic Sex-Based Inequity in the MELD Score-Based Allocation System for Liver Transplantation in Germany |
| title_short | Systematic Sex-Based Inequity in the MELD Score-Based Allocation System for Liver Transplantation in Germany |
| title_sort | systematic sex based inequity in the meld score based allocation system for liver transplantation in germany |
| topic | organ procurement and allocation model for end-stage liver disease end stage liver disease disparities gender sex inequity |
| url | https://www.frontierspartnerships.org/articles/10.3389/ti.2025.13844/full |
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