Sex and body size disparities under MELD 3.0: Evaluation of persisting gaps in liver transplant access

By Internal Medicine at Iowa
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Article: Sex and body size disparities under MELD 3.0: Evaluation of persisting gaps in liver transplant access

Authors: Tomohiro Tanaka, Dan M Shane, Jennifer C Lai

Journal: Hepatology. 2025 Oct 16. doi: 10.1097/HEP.0000000000001581. Online ahead of print

Abstract:
Background: The July 2023 implementation of MELD3.0 aimed to address longstanding sex disparities in liver transplant (LT) access. However, its impact has been understudied.

Methods: We analyzed US transplant registry data (2/4/2020-9/30/2024) among adult LT candidates. Using a difference-in-differences (DiD) design, we assessed the impact of MELD3.0 during immediate and 3-month post-implementation (“burn-in”) periods on receipt of: 1) a top 5 organ offer or 2) transplant. Poisson and logistic models estimated offer and transplant probabilities. Mediation and subgroup analyses by height were also conducted.

Result: We analyzed 9,952,473 person-day observations from 60,159 LT candidates. Following MELD3.0, women had greater relative increases in top 5 organ offer rates (rate ratio [RR] 1.141.251.37 at implementation; RR 1.111.161.22 at three months). Pre-MELD3.0, transplant rates were lower for women than men (odds ratio [OR] 0.840.860.89). Post-policy, women had greater relative improvements in transplant access than men (OR 1.161.361.60 at implementation; 1.091.181.29 at three months), but this advantage diminished over time, with the model-estimated improvement for women relative to men declining to OR 0.81 by the study end. In mediation analysis, adjustment for height eliminated the difference in transplant rates by sex (OR 0.981.011.05). Among taller (≥166 cm) candidates, baseline differences by sex persisted (OR 0.890.920.96), but not in the shorter (<166 cm) group (OR 0.920.971.03). Post-policy, the benefit for women was more pronounced in shorter candidates (OR 1.191.471.83).

Conclusion: MELD3.0 led to early gains in transplant access for women, though this effect diminished over time and differences by sex mediated by body size persisted.

Link to journal online: https://journals.lww.com/hep/abstract/9900/sex_and_body_size_disparities_under_meld_3_0_.1441.aspx

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