@article{10902/34435, year = {2024}, url = {https://hdl.handle.net/10902/34435}, abstract = {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.}, organization = {Funding: Instituto de Salud Carlos III, Agencia Estatal de Investigación (Spain), and European Union. Acknowledgements: The present study was supported by the Spanish Ministry of Research and Innovation, the “Instituto de Salud Carlos III” (grant reference PI22/00312), the “Agencia Estatal de Investigación (España)” (grant reference: PID2020-115454GB-C22/AEI/10.13039/501100011033), and co-funded by the European Union. AMG-O was supported by “Consejería de Transformación Económica, Industria, Conocimiento y Universidades de la Junta de Andalucía” (grant reference: PREDOC-00489). DG-R was supported by the “Agencia Estatal de Investigación (España)” and European Union NextGenerationEU/PRTR (grant ref.: JDC2022-048378-I). We would like to acknowledge the labour of Dr. Rafael Garrido García and Ms. Eva Bech who kindly provided advice for the study design on behalf of the “Fundación Nacional de pacientes Trasplantados Hepáticos (FNETH)”, which is the national association of people living with a liver transplant in Spain. We also thank the Spanish hepatologist women group (GEMHep) for their continuous support, with some of its members actively involved in the project from its inception.}, publisher = {Elsevier}, publisher = {eClinicalMedicine, 2024, 74, 102737}, title = {GEMA-Na and MELD 3.0 severity scores to address sex disparities for accessing liver transplantation: a nationwide retrospective cohort study}, author = {Rodríguez-Perálvarez, Manuel Luis and Rosa, Gloria de la and Gómez-Orellana, Antonio Manuel and Aguilera, María Victoria and Pascual Vicente, Teresa and Pereira, Sheila and Ortiz, María Luisa and Pagano, Giulia and Suárez, Francisco and González Grande, Rocío and Cachero, Alba and Tomé, Santiago and Barreales, Mónica and Martín Mateos, Rosa and Pascual, Sonia and Romero, Mario and Bilbao, Itxarone and Alonso Martín, Carmen and Cuadrado Lavín, Antonio}, }