Manuel Luis Rodríguez-Perálvarez, Gloria de la Rosa, Antonio Manuel Gómez-Orellana, María Victoria Aguilera, Teresa Pascual Vicente, Sheila Pereira, María Luisa Ortiz, Giulia Pagano, Francisco Suarez, Rocío González Grande, Alba Cachero, Santiago Tomé, Mónica Barreales, Rosa Martín Mateos, Sonia Pascual, Mario Romero, Itxarone Bilbao, Carmen Alonso Martín, Elena Otón, Luisa González Diéguez, María Dolores Espinosa, Ana Arias Milla, Gerardo Blanco Fernández, Sara Lorente, Antonio Cuadrado Lavín, Amaya Redín García, Clara Sánchez Cano, Carmen Cepeda-Franco, José Antonio Pons, Jordi Colmenero, David Guijo-Rubio, Alejandra Otero, Alberto Amador Navarrete, Sarai Romero Moreno, María Rodríguez Soler, César Hervás Martínez, Mikel Gastaca
{"title":"用 GEMA-Na 和 MELD 3.0 严重程度评分解决肝移植手术性别差异问题：一项全国性回顾性队列研究。","authors":"Manuel Luis Rodríguez-Perálvarez, Gloria de la Rosa, Antonio Manuel Gómez-Orellana, María Victoria Aguilera, Teresa Pascual Vicente, Sheila Pereira, María Luisa Ortiz, Giulia Pagano, Francisco Suarez, Rocío González Grande, Alba Cachero, Santiago Tomé, Mónica Barreales, Rosa Martín Mateos, Sonia Pascual, Mario Romero, Itxarone Bilbao, Carmen Alonso Martín, Elena Otón, Luisa González Diéguez, María Dolores Espinosa, Ana Arias Milla, Gerardo Blanco Fernández, Sara Lorente, Antonio Cuadrado Lavín, Amaya Redín García, Clara Sánchez Cano, Carmen Cepeda-Franco, José Antonio Pons, Jordi Colmenero, David Guijo-Rubio, Alejandra Otero, Alberto Amador Navarrete, Sarai Romero Moreno, María Rodríguez Soler, César Hervás Martínez, Mikel Gastaca","doi":"10.1016/j.eclinm.2024.102737","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The Gender-Equity Model for liver Allocation corrected by serum sodium (GEMA-Na) and the Model for End-stage Liver Disease 3.0 (MELD 3.0) could amend sex disparities for accessing liver transplantation (LT). We aimed to assess these inequities in Spain and to compare the performance of GEMA-Na and MELD 3.0.</p><p><strong>Methods: </strong>Nationwide cohort study including adult patients listed for a first elective LT (January 2016-December 2021). The primary outcome was mortality or delisting for sickness within the first 90 days. Independent predictors of the primary outcome were evaluated using multivariate Cox's regression with adjusted relative risks (RR) and 95% confidence intervals (95% CI). The discrimination of GEMA-Na and MELD 3.0was assessed using Harrell c-statistics (Hc).</p><p><strong>Findings: </strong>The study included 6071 patients (4697 men and 1374 women). Mortality or delisting for clinical deterioration occurred in 286 patients at 90 days (4.7%). Women had reduced access to LT (83.7% vs. 85.9%; p = 0.037) and increased risk of mortality or delisting for sickness at 90 days (adjusted RR = 1.57 [95% CI 1.09-2.28]; p = 0.017). Female sex remained as an independent risk factor when using MELD or MELD-Na but lost its significance in the presence of GEMA-Na or MELD 3.0. Among patients included for reasons other than tumours (n = 3606; 59.4%), GEMA-Na had Hc = 0.753 (95% CI 0.715-0.792), which was higher than MELD 3.0 (Hc = 0.726 [95% CI 0.686-0.767; p = 0.001), showing both models adequate calibration.</p><p><strong>Interpretation: </strong>GEMA-Na and MELD 3.0 might correct sex disparities for accessing LT, but GEMA-Na provides more accurate predictions of waiting list outcomes and could be considered the standard of care for waiting list prioritization.</p><p><strong>Funding: </strong>Instituto de Salud Carlos III, Agencia Estatal de Investigación (Spain), and European Union.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":null,"pages":null},"PeriodicalIF":9.6000,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304699/pdf/","citationCount":"0","resultStr":"{\"title\":\"GEMA-Na and MELD 3.0 severity scores to address sex disparities for accessing liver transplantation: a nationwide retrospective cohort study.\",\"authors\":\"Manuel Luis Rodríguez-Perálvarez, Gloria de la Rosa, Antonio Manuel Gómez-Orellana, María Victoria Aguilera, Teresa Pascual Vicente, Sheila Pereira, María Luisa Ortiz, Giulia Pagano, Francisco Suarez, Rocío González Grande, Alba Cachero, Santiago Tomé, Mónica Barreales, Rosa Martín Mateos, Sonia Pascual, Mario Romero, Itxarone Bilbao, Carmen Alonso Martín, Elena Otón, Luisa González Diéguez, María Dolores Espinosa, Ana Arias Milla, Gerardo Blanco Fernández, Sara Lorente, Antonio Cuadrado Lavín, Amaya Redín García, Clara Sánchez Cano, Carmen Cepeda-Franco, José Antonio Pons, Jordi Colmenero, David Guijo-Rubio, Alejandra Otero, Alberto Amador Navarrete, Sarai Romero Moreno, María Rodríguez Soler, César Hervás Martínez, Mikel Gastaca\",\"doi\":\"10.1016/j.eclinm.2024.102737\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The Gender-Equity Model for liver Allocation corrected by serum sodium (GEMA-Na) and the Model for End-stage Liver Disease 3.0 (MELD 3.0) could amend sex disparities for accessing liver transplantation (LT). We aimed to assess these inequities in Spain and to compare the performance of GEMA-Na and MELD 3.0.</p><p><strong>Methods: </strong>Nationwide cohort study including adult patients listed for a first elective LT (January 2016-December 2021). The primary outcome was mortality or delisting for sickness within the first 90 days. Independent predictors of the primary outcome were evaluated using multivariate Cox's regression with adjusted relative risks (RR) and 95% confidence intervals (95% CI). The discrimination of GEMA-Na and MELD 3.0was assessed using Harrell c-statistics (Hc).</p><p><strong>Findings: </strong>The study included 6071 patients (4697 men and 1374 women). Mortality or delisting for clinical deterioration occurred in 286 patients at 90 days (4.7%). Women had reduced access to LT (83.7% vs. 85.9%; p = 0.037) and increased risk of mortality or delisting for sickness at 90 days (adjusted RR = 1.57 [95% CI 1.09-2.28]; p = 0.017). Female sex remained as an independent risk factor when using MELD or MELD-Na but lost its significance in the presence of GEMA-Na or MELD 3.0. Among patients included for reasons other than tumours (n = 3606; 59.4%), GEMA-Na had Hc = 0.753 (95% CI 0.715-0.792), which was higher than MELD 3.0 (Hc = 0.726 [95% CI 0.686-0.767; p = 0.001), showing both models adequate calibration.</p><p><strong>Interpretation: </strong>GEMA-Na and MELD 3.0 might correct sex disparities for accessing LT, but GEMA-Na provides more accurate predictions of waiting list outcomes and could be considered the standard of care for waiting list prioritization.</p><p><strong>Funding: </strong>Instituto de Salud Carlos III, Agencia Estatal de Investigación (Spain), and European Union.</p>\",\"PeriodicalId\":11393,\"journal\":{\"name\":\"EClinicalMedicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":9.6000,\"publicationDate\":\"2024-07-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304699/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"EClinicalMedicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.eclinm.2024.102737\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"EClinicalMedicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.eclinm.2024.102737","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
GEMA-Na and MELD 3.0 severity scores to address sex disparities for accessing liver transplantation: a nationwide retrospective cohort study.
Background: The Gender-Equity Model for liver Allocation corrected by serum sodium (GEMA-Na) and the Model for End-stage Liver Disease 3.0 (MELD 3.0) could amend sex disparities for accessing liver transplantation (LT). We aimed to assess these inequities in Spain and to compare the performance of GEMA-Na and MELD 3.0.
Methods: Nationwide cohort study including adult patients listed for a first elective LT (January 2016-December 2021). The primary outcome was mortality or delisting for sickness within the first 90 days. Independent predictors of the primary outcome were evaluated using multivariate Cox's regression with adjusted relative risks (RR) and 95% confidence intervals (95% CI). The discrimination of GEMA-Na and MELD 3.0was assessed using Harrell c-statistics (Hc).
Findings: The study included 6071 patients (4697 men and 1374 women). Mortality or delisting for clinical deterioration occurred in 286 patients at 90 days (4.7%). Women had reduced access to LT (83.7% vs. 85.9%; p = 0.037) and increased risk of mortality or delisting for sickness at 90 days (adjusted RR = 1.57 [95% CI 1.09-2.28]; p = 0.017). Female sex remained as an independent risk factor when using MELD or MELD-Na but lost its significance in the presence of GEMA-Na or MELD 3.0. Among patients included for reasons other than tumours (n = 3606; 59.4%), GEMA-Na had Hc = 0.753 (95% CI 0.715-0.792), which was higher than MELD 3.0 (Hc = 0.726 [95% CI 0.686-0.767; p = 0.001), showing both models adequate calibration.
Interpretation: GEMA-Na and MELD 3.0 might correct sex disparities for accessing LT, but GEMA-Na provides more accurate predictions of waiting list outcomes and could be considered the standard of care for waiting list prioritization.
Funding: Instituto de Salud Carlos III, Agencia Estatal de Investigación (Spain), and European Union.
期刊介绍：
eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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