Sunday, November 15, 2015

Underestimating Women's Renal Function Puts Them at Lower Priority on the Transplantation List

PR Newswire

FRANCISCO, Nov. 15, 2015 /PRNewswire/ -- The allocation of scarce liver organs for transplantation is an important and complex issue. The Model for End-Stage Liver Disease (MELD) score is a remarkably good tool to prioritize the livers to the sickest candidates. However, since the introduction of MELD score in liver allocation, women became less likely than men to undergo LT.

Glomerular filtration rate (GFR) is the rate of filtered fluid through the kidney. Serum creatinine is an indicator of renal health, and is used in equations of GFR estimation, as well as in MELD score. Because women have lower muscle mass, they routinely have a lower level of creatinine production. A more accurate assessment of a patient's renal function could be obtained by measuring glomerular filtration.

Researchers from the Mayo Clinic and Stanford University presented data at The Liver Meeting®, the annual meeting of the American Association for the Study of Liver Diseases, that demonstrate that the use of creatinine as an indicator of kidney health in MELD scores results in a bias against women waiting for liver transplantation.

"Women are disadvantaged in the current allocation system," according to Alina M. Allen, MD, who is the principal investigator for the study. She continues, "They are 20 percent less likely than men to receive a liver organ. Our analysis of 97,371 waitlisted subjects in the UNOS database from 2002 to 2013 shows that most of the disparity is derived from their shorter stature, as it can be technically difficult to transplant a large liver into a much smaller body. Additionally, men are more likely to receive exception MELD points, largely due to the higher incidence of hepatocellular carcinoma. However, even after accounting for these biologically plausible differences between sexes, a liver transplant deficit (albeit lower, of 8%) in women remains." Continue reading


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