MELD 3.0 reduces sex-based disparities in liver transplant access, waitlist outcomes

Key takeaways:

• Waitlist survival at 90 days improved from 86.5% before MELD 3.0 to 90.9% after implementation among women.
• Transplant rates among women increased from 37.3% to 42.1%, and median MELD decreased from 29 to 27.

SAN DIEGO — Waitlist mortality and liver transplant rates for women appear to more closely align with rates for men after the implementation of MELD 3.0, according to late-breaking data presented at The Liver Meeting.

“The MELD score has effectively and efficiently ordered the liver transplant waiting list in a sickest-first system for liver allocation,” Allison Kwong, MD, transplant hepatologist and assistant professor of medicine in the department of gastroenterology and hepatology at Stanford Health Care, said. “Under this system, however, there have been sex-based disparities in liver transplant that have been identified, where men have a lower pretransplant mortality rate and higher deceased-donor liver transplant rates compared to women.”

According to Kwong, the Organ Procurement and Transplantation Network (OPTN) updated MELD-Na to MELD 3.0 in July 2023, adding female sex and albumin as variables to improve the prediction of mortality and correct sex-based disparities.

Using data from the OPTN, Kwong and colleagues used the OPTN database to identify liver transplant candidates and recipients aged 12 years and older through October 2024.

The researchers compared 90-day waitlist outcomes during the 12 months before (n = 10,568; median age, 55 years; 40.4% women; median MELD, 23) and after (n = 11,749; median age, 55 years; 43.7% women; median MELD, 22) policy implementation, as well as trends in deceased-donor transplantation.

According to Kwong, waitlist survival at 90 days improved from 86.5% before MELD 3.0 to 90.9% after implementation among women and from 90.2% to 92.6%, respectively, among men. In addition, deceased-donor transplant rates between sexes “equalized” in the overall transplant system following implementation of MELD 3.0.

When evaluating characteristics of transplant recipients, Kwong reported that transplant rates among women increased from 37.3% before MELD 3.0 to 42.1% after, while the median MELD decreased from 29 to 27.

However, the post-policy median allocation MELD score at transplant remained higher for women compared with men (29 vs. 27), Kwong noted, which may indicate persistent disparities in transplant access between sexes.

“After the implementation of MELD 3.0, we see a higher proportion of the waiting list and the transplants being women and that waitlist mortality and transplant rates for women now more closely approximate the rates for men,” Kwong told attendees. “Transplant outcomes have improved year over year, and that’s related to external factors, including the increased donor availability.”

She continued, “We can see from our data that MELD 3.0 has worked as intended and has successfully mitigated at least some disparities in waitlist outcomes and transplant access.”