This Article  • Full text  • PDF  • JAMA Report Video  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (2)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Medical Practice  • Medical Practice, Other  • Transplantation  • Liver Transplantation  • Women's Health  • Women's Health, Other  • Gastroenterology  • Liver/ Biliary Tract/ Pancreatic Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Cynthia A. Moylan, MD; Carla W. Brady, MD, MHS; Jeffrey L. Johnson, MS; Alastair D. Smith, MB, ChB; Janet E. Tuttle-Newhall, MD; Andrew J. Muir, MD, MHS

JAMA. 2008;300(20):2371-2378.

Context  In February 2002, the allocation system for liver transplantation became based on the Model for End-Stage Liver Disease (MELD) score. Before MELD, black patients were more likely to die or become too sick to undergo liver transplantation compared with white patients. Little information exists regarding sex and access to liver transplantation.

Objective  To determine the association between race, sex, and liver transplantation following introduction of the MELD system.

Design, Setting, and Patients  A retrospective cohort of black and white patients (18 years) registered on the United Network for Organ Sharing liver transplantation waiting list between January 1, 1996, and December 31, 2000 (pre-MELD cohort, n = 21 895) and between February 28, 2002, and March 31, 2006 (post-MELD cohort, n = 23 793).

Main Outcome Measures  Association between race, sex, and receipt of a liver transplant. Separate multivariable analyses evaluated cohorts within each period to identify predictors of time to death and the odds of dying or receiving liver transplantation within 3 years of listing. Patients with hepatocellular carcinoma were analyzed separately.

Results  Black patients were younger (mean [SD], 49.2 [10.7] vs 52.4 [9.2] years; P < .001) and sicker (MELD score at listing: median [interquartile range], 16 [12-22] vs 14 [11-19]; P < .001) than white patients on the waiting list for both periods. In the pre-MELD cohort, black patients were more likely to die or become too sick for liver transplantation than white patients (27.0% vs 21.7%) within 3 years of registering on the waiting list (odds ratio [OR], 1.51; 95% confidence interval (CI), 1.15-1.98; P = .003). In the post-MELD cohort, black race was no longer associated with increased likelihood of death or becoming too sick for liver transplantation (26.5% vs 22.0%, respectively; OR, 0.96; 95% CI, 0.74-1.26; P = .76). Black patients were also less likely to receive a liver transplant than white patients within 3 years of registering on the waiting list pre-MELD (61.6% vs 66.9%; OR, 0.75; 95% CI, 0.59-0.97; P = .03), whereas post-MELD, race was no longer significantly associated with receipt of a liver transplant (47.5% vs 45.5%, respectively; OR, 1.04; 95% CI, 0.84-1.28; P = .75). Women were more likely than men to die or become too sick for liver transplantation post-MELD (23.7% vs 21.4%; OR, 1.30; 95% CI, 1.08-1.47; P = .003) vs pre-MELD (22.4% vs 21.9%; OR, 1.08; 95% CI, 0.91-1.26; P = .37). Similarly, women were less likely than men to receive a liver transplant within 3 years both pre-MELD (64.8% vs 67.6%; OR, 0.80; 95% CI, 0.70-0.92; P = .002) and post-MELD (39.9% vs 48.7%; OR, 0.70; 95% CI, 0.62-0.79; P < .001).

Conclusion  Following introduction of the MELD score to the liver transplantation allocation system, race was no longer associated with receipt of a liver transplant or death on the waiting list, but disparities based on sex remain.

Author Affiliations: Division of Gastroenterology (Drs Moylan, Brady, Smith, and Muir), Comprehensive Cancer Center (Mr Johnson), and Division of General Surgery and Critical Care (Dr Tuttle-Newhall), Duke University Medical Center, Durham, North Carolina.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Race and Sex Disparities in Liver Transplantation: Progress Toward Achieving Equal Access?
and
JAMA. ;300():2425-2426.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Assessment of reproducibility of creatinine measurement and MELD scoring in four liver transplant units in the UK
Goulding et al.
Nephrol Dial Transplant 2009;0:gfp556v1-gfp556.
ABSTRACT | FULL TEXT  

Beyond Outcomes--The Appropriateness of Surgical Care
Lee and Ko
JAMA 2009;302:1580-1581.
FULL TEXT  

Race and Sex Disparities in Liver Transplantation: Progress Toward Achieving Equal Access?
Axelrod and Pomfret
JAMA 2008;300:2425-2426.
FULL TEXT