Date: Saturday, May 30, 2020
Session Name: Liver: MELD, Allocation and Donor Issues (DCD/ECD) I
Session Time: 3:15pm-4:45pm
Presentation Time: 3:39pm-3:51pm
*Purpose: Differences in local organ supply and demand have introduced geographic inequities in the Model for End-stage Liver Disease (MELD) based liver allocation system prompting national debate and patient-initiated lawsuits. The debate is rooted in two key assumptions: MELD accurately predicts disease severity, and candidates with the highest MELD at the top of the list receive the liver transplant. Data suggest these assumptions are routinely violated, particularly among female candidates, and to-date, no study has quantified the amount of disparity in allocation that can be attributed to clinical versus geographic characteristics. The goal of this study was to estimate the proportion of the gender disparity in waitlist mortality (WLM) and deceased donor liver transplant (DDLT) mediated by clinical and geographic characteristics.
*Methods: Retrospective cohort study of adult (>18 years) liver-only transplant listings reported to the Organ Procurement and Transplantation Network from June 18, 2013-March 1, 2018 (n=81,357; Female=29,384; Male=51,973). Multivariate Cox proportional hazard models were constructed for WLM and DDLT and inverse odd ratio weighting estimated the proportion of disparity across three domains – geography, MELD, and candidate size.
*Results: Compared to men, women were 9% more likely to die waiting and 14% less likely to be transplanted. In the geography domain, Organ Procurement Organization was the only significant mediator increasing the relationship between female gender and WLM by 22%; no measure of geography mediated DDLT. Lab and allocation MELD were strong mediators of female gender and WLM and DDLT increasing the relationship by 50% and 10%, respectively. The strongest mediators of gender-based disparities were in the size domain increasing the relationship between female gender and WLM and DDLT by 125% and 49%, respectively.
*Conclusions: Our findings inform the ongoing debate regarding disparities in liver allocation and suggest that addressing geographic disparities in isolation will not mitigate gender-based disparities which have been driven by the failure of MELD to accurately predict disease severity in women and to account for candidate size.
To cite this abstract in AMA style:Shelton BA, Olthoff K, Pomfret E, Forde KA, Sawinski D, Gray M, Ascher N, Locke JE. Quantifying Gender-Based Disparties in Liver Allocation: A Path Forward [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/quantifying-gender-based-disparties-in-liver-allocation-a-path-forward/. Accessed October 27, 2020.
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