Gender-Equity Model for Liver Allocation more accurately predicts mortality vs. MELD
Click Here to Manage Email Alerts
LONDON — The Gender-Equity Model for Liver Allocation and its sodium-corrected variant were better predictors of mortality or delisting in patients awaiting liver transplantation and may correct gender disparities, according to research.
“The odds of delisting for sickness in women are 30% higher than in men, and this may have something to do with serum creatinine,” Manuel Rodríguez-PerálvarezMD, associate professor of medicine at the University of Córdoba in Spain, said at the International Liver Congress. “We derived and validated a new model that replaced creatinine with the Royal Free [Hospital] glomerular filtration rate within the MELD and the MELD sodium-corrected formulas.”
Rodríguez-Perálvarez and colleagues included 5,762 patients for model training and 1,920 1,920 patients for internally validation of the Gender-Equity Model for Liver Allocation (GEMA) and its sodium-corrected variant (GEMA-Na), all of whom were listed for LT in the United Kingdom. They conducted external validation of the model in 1,638 patients from an Australian cohort. The primary outcome was mortality or clinical deterioration-associated delisting at 90 days.
Among all 9,320 patients, the prevalence of mortality or delisting for sickness ranged from 5.3% to 6%. Patients in the internal validation cohort yielded a Harrell’s c-statistic score of 0.752 for GEMA and 0.766 for GEMA-Na, which were higher compared with MELD (0.712) and MELD-Na (0.742) scores. Researchers noted consistent results among patients in the external validation cohort.
Further analysis showed 43.9% and 41.8% of patients were prioritized differently with GEMA and GEMA-Na, respectively. Women were more often prioritized by GEMA-Na, as were patients with a higher prevalence of ascites and those at triple risk for mortality or delisting compared with patients prioritized by MELD-Na.
Rodríguez-Perálvarez concluded that using GEMA instead of MELD could prevent 1 in 15 deaths and using GEMA-Na instead of MELD-Na could prevent 1 in 21 deaths. One in 8 deaths could be avoided among women using either model.
“GEMA, which replaces serum creatinine by Royal Free glomerular filtration rate, predicts mortality or delisting for sickness in patients awaiting LT more accurately than MELD, MELD-Na and MELD 3.0,” Rodríguez-Perálvarez said. “The discrimination benefit is highest among women, suggesting the ability of GEMA to amend gender disparities. These results are consistent in two large cohorts from different countries and organ allocation systems.”
Collapse
Manuel Rodríguez-Perálvarez, et al. Abstract GS005. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).
Read more about
Click Here to Manage Email Alerts