Journal article
Body Size Remains the Major Source of Sex Disparity Despite Updated Liver Transplant Allocation Policies
Transplantation, Vol.108(12), pp.e396-e403
12/2024
DOI: 10.1097/TP.0000000000005142
PMID: 39020468
Abstract
Efforts to address US liver transplant (LT) access inequities continue, yet disparities linked to candidate traits persist.BACKGROUNDEfforts to address US liver transplant (LT) access inequities continue, yet disparities linked to candidate traits persist.Analyzing national registry data pre- and post-Acuity Circle (AC) policy, our study assessed the impact of low body surface area (BSA) on LT waitlist mortality. The outcomes of LT candidates listed in the pre-AC era (n = 39 227) and post-AC (n = 38 443) were compared for patients with low BSA (22.9% pre-AC and 23.3% post-AC).METHODSAnalyzing national registry data pre- and post-Acuity Circle (AC) policy, our study assessed the impact of low body surface area (BSA) on LT waitlist mortality. The outcomes of LT candidates listed in the pre-AC era (n = 39 227) and post-AC (n = 38 443) were compared for patients with low BSA (22.9% pre-AC and 23.3% post-AC).Fine-Gray competing risk models highlighted that candidates with low BSA had a lower likelihood of LT both pre-AC (hazard ratio [HR] 0.93; 95% confidence interval [CI], 0.92-0.95) and post-AC (HR 0.96; 95% CI, 0.94-0.98), with minimal improvement in waitlist mortality/dropout risk from pre-AC (HR 1.15; 95% CI, 1.09-1.21) to post-AC (HR 1.13; 95% CI, 1.06-1.19). Findings were mostly reaffirmed by Cox regression models incorporating the trajectory of Model for End-stage Liver Disease (MELD) scores as time-dependent covariates. Regions 3, 5, and 7 showed notable LT waitlist disparities among low BSA patients post-AC policy. Causal mediation analysis revealed that low BSA and the difference between MELD-sodium and MELD 3.0 (MELD_D, as a proxy for the potential impact of the introduction of MELD 3.0) largely explained the sex disparity in AC allocation (percent mediated 90.4).RESULTSFine-Gray competing risk models highlighted that candidates with low BSA had a lower likelihood of LT both pre-AC (hazard ratio [HR] 0.93; 95% confidence interval [CI], 0.92-0.95) and post-AC (HR 0.96; 95% CI, 0.94-0.98), with minimal improvement in waitlist mortality/dropout risk from pre-AC (HR 1.15; 95% CI, 1.09-1.21) to post-AC (HR 1.13; 95% CI, 1.06-1.19). Findings were mostly reaffirmed by Cox regression models incorporating the trajectory of Model for End-stage Liver Disease (MELD) scores as time-dependent covariates. Regions 3, 5, and 7 showed notable LT waitlist disparities among low BSA patients post-AC policy. Causal mediation analysis revealed that low BSA and the difference between MELD-sodium and MELD 3.0 (MELD_D, as a proxy for the potential impact of the introduction of MELD 3.0) largely explained the sex disparity in AC allocation (percent mediated 90.4).LT waitlist disparities for female candidates persist, largely mediated by small body size. Although MELD 3.0 may reduce some disparities, further body size adjustments for in allocation models are justified.CONCLUSIONSLT waitlist disparities for female candidates persist, largely mediated by small body size. Although MELD 3.0 may reduce some disparities, further body size adjustments for in allocation models are justified.
Details
- Title: Subtitle
- Body Size Remains the Major Source of Sex Disparity Despite Updated Liver Transplant Allocation Policies
- Creators
- Tomohiro Tanaka - University of Iowa, Gastroenterology and HepatologyKatherine Ross-Driscoll - Indiana University School of MedicineSmita Pancholia - University of IowaDavid Axelrod - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Transplantation, Vol.108(12), pp.e396-e403
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- DOI
- 10.1097/TP.0000000000005142
- PMID
- 39020468
- ISSN
- 1534-6080
- eISSN
- 1534-6080
- Grant note
- AHRQ Mentored Clinical Scientist Research Career Development Award: K08HS029195-01A1
T.T. is supported by AHRQ Mentored Clinical Scientist Research Career Development Award (K08) K08HS029195-01A1
- Language
- English
- Electronic publication date
- 07/18/2024
- Date published
- 12/2024
- Academic Unit
- Health Management and Policy; Gastroenterology and Hepatology; Surgery; Internal Medicine
- Record Identifier
- 9984658353102771
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