Session Name: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Date & Time: None. Available on demand.
*Purpose: Since the introduction of the MELD-based allocation system, women are now 30% less likely than men to undergo LT and have 20% higher waitlist mortality. These disparities are largely due to height differences in men and women though no national policies have been proposed to reduce sex disparities.
*Methods: Patients were identified using the Scientific Registry of Transplant Recipients (SRTR) from 2014-2019. Patients were categorized into five groups by first dividing into thirds by height then dividing the shortest third into three groups to capture more granular differences in the most disadvantaged patients (<166 cm). We then used LSAM to model waitlist outcomes in five versions of awarding additional MELD points based on height categories compared to current policy. These scenarios award varying points to the three shortest height cohorts. For example, scenario “2,1,0” awards two additional points to the <150cm cohort, one to the 151-156cm cohort, and zero to the 157-165cm cohort.
*Results: Patients (n=75,501) had a mean age of 55 years and median listing MELD of 15. Patients in the shortest categories were overwhelmingly female (96% of ≤150cm and 94% of 151-156cm versus 2.8% of ≥176cm). We re-demonstrated that shorter height is associated with decreased LT and increased risk of death without LT (for example, 24.5% dropout for ≤150cm and 21.6% for 151-156cm vs. 16.4% for ≥176cm). Two LSAM scenarios, “1,1,0” and “2,1,0” resulted in the greatest improvement in LT and death percentage for the shortest candidates with the least negative impact on taller candidates (Table, Figure). The patients who benefitted most in these two scenarios were patients <150cm and 151-156cm. For example, in the “1,1,0” scenario, LT for patients <150cm increased from 35.9% to 38.7% and death decreased from 11% to 10.7% with minimal impact on patients ≥176cm whose LT percentage went from 41% to 40.5% and death from 8.4% to 8.5%.
|LSAM Outcomes (LT % / Death without LT %)|
|Height Group (centimeters)||Number of LT candidates (%) (n=75,501)||Current||(1,0,0)||(1,1,0)||(1,1,1)||(2,1,0)||(3,2,1)|
|≤ 150||1,537 (2.0%)||35.9/11.0||39.6/10.3||38.7/10.7||38.1/10.5||42.1/9.9||43.3/9.7|
|151 – 156||4,369 (5.8%)||37.5/9.7||37.0/9.7||40.1/9.3||39.4/9.4||40.1/9.3||42.0/9.0|
|157 – 165||18,588 (25%)||39.2/9.4||39.1/9.3||38.9/9.4||41.4/9.1||38.9/9.4||41.2/9.1|
|166 – 175||25,984 (34%)||40.1/8.7||39.7/8.7||39.5/8.7||38.7/8.9||39.5/8.7||38.4/8.9|
|≥ 176||25,023 (33%)||41.0/8.4||40.7/8.5||40.5/8.5||39.7/8.7||40.4/8.6||39.2/8.8|
*Conclusions: Awarding an additional 1-2 MELD points to the shortest 8% of LT candidates would improve waitlist outcomes for women with minimal impact on men. This strategy should be considered in national policy allocation in an effort to address sex-based disparities in LT.
To cite this abstract in AMA style:Bernards S, Lee E, Leung N, Zhao H, Akan M, Sarkar M, Tayur S, Mehta N. Liver Simulated Allocation Model (LSAM) of a Height-Based Policy Change to Improve Sex Disparity in Liver Transplantation (LT) [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/liver-simulated-allocation-model-lsam-of-a-height-based-policy-change-to-improve-sex-disparity-in-liver-transplantation-lt/. Accessed June 13, 2021.
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