Journal article
Sex and body size disparities under MELD 3.0: Evaluation of persisting gaps in liver transplant access
Hepatology (Baltimore, Md.)
10/16/2025
DOI: 10.1097/HEP.0000000000001581
PMID: 41100798
Abstract
The July 2023 implementation of MELD3.0 aimed to address longstanding sex disparities in liver transplant (LT) access. However, its impact has been understudied.
We analyzed US transplant registry data (2/4/2020-9/30/2024) among adult LT candidates. Using a difference-in-differences (DiD) design, we assessed the impact of MELD3.0 during immediate and 3-month post-implementation ("burn-in") periods on receipt of: 1) a top 5 organ offer or 2) transplant. Poisson and logistic models estimated offer and transplant probabilities. Mediation and subgroup analyses by height were also conducted.
We analyzed 9,952,473 person-day observations from 60,159 LT candidates. Following MELD3.0, women had greater relative increases in top 5 organ offer rates (rate ratio [RR] 1.141.251.37 at implementation; RR 1.111.161.22 at three months). Pre-MELD3.0, transplant rates were lower for women than men (odds ratio [OR] 0.840.860.89). Post-policy, women had greater relative improvements in transplant access than men (OR 1.161.361.60 at implementation; 1.091.181.29 at three months), but this advantage diminished over time, with the model-estimated improvement for women relative to men declining to OR 0.81 by the study end. In mediation analysis, adjustment for height eliminated the difference in transplant rates by sex (OR 0.981.011.05). Among taller (≥166 cm) candidates, baseline differences by sex persisted (OR 0.890.920.96), but not in the shorter (<166 cm) group (OR 0.920.971.03). Post-policy, the benefit for women was more pronounced in shorter candidates (OR 1.191.471.83).
MELD3.0 led to early gains in transplant access for women, though this effect diminished over time and differences by sex mediated by body size persisted.
Details
- Title: Subtitle
- Sex and body size disparities under MELD 3.0: Evaluation of persisting gaps in liver transplant access
- Creators
- Tomohiro Tanaka - University of IowaDan M Shane - University of IowaJennifer C Lai - University of California, San Francisco
- Resource Type
- Journal article
- Publication Details
- Hepatology (Baltimore, Md.)
- DOI
- 10.1097/HEP.0000000000001581
- PMID
- 41100798
- NLM abbreviation
- Hepatology
- ISSN
- 1527-3350
- eISSN
- 1527-3350
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Grant note
- AHRQ Mentored Clinical Scientist Research Career Development: K08HS029195-01A1, K24AG080021, R01DK133527, R01AG059183, P30DK026743
Tomohiro Tanaka is supported by AHRQ Mentored Clinical Scientist Research Career Development Award(K08): K08HS029195-01A1. Jennifer C. Lai is sup-ported by the following grants: K24AG080021,R01DK133527, R01AG059183, and P30DK026743.
- Language
- English
- Electronic publication date
- 10/16/2025
- Academic Unit
- Health Management and Policy; Economics; Gastroenterology and Hepatology; Internal Medicine
- Record Identifier
- 9985014805102771
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