Livers are allocated according to MELD score without regard to patient demographics. However, MELD-adjusted risk of death may vary by sex, since serum creatinine level is affected by physiological factors such as total muscle mass.

METHODS: Using SRTR data, we analyzed mortality rates of 83,878 adult waiting list registrants enrolled between 3/2002-3/2014, censoring at 5 yr of follow-up. We studied association of sex with biological risk of death (using Cox regression) and risk of death prior to transplant (using competing risks regression), adjusting for candidate characteristics.

RESULTS: Among patients with the same MELD score, women were at higher risk of death (aHR=1.07, 95% CI: 1.04-1.11, p<0.05). Relative risk based on sex differed by MELD categories (interaction p<0.05, Figure 1). Between MELD 21-30, risk for women was 21% higher than men with the same MELD score (aHR=1.21, 95%CI: 1.14-1.28, p<0.05).

Accounting for transplantation as a competing risk, women had higher MELD-adjusted risk of death prior to transplant (aSHR=1.22, 95%CI: 1.18-1.26, p<0.05). In other words, women were 22% more likely than men to die prior to receiving a transplant.

CONCLUSIONS: MELD-adjusted death rates vary by sex. Women may be disadvantaged under the current MELD-based allocation scheme.

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