Impact of creatinine values on MELD scores in male and female candidates for liver transplantation

• Published in: Annals of hepatology 2013-05, Vol.12 (3), p.434-439
• Main Authors: Mariante-Neto, Guilherme, Marroni, Caroline P, Fleck Junior, Alfeude Medeiros, Marroni, Cláudio Augusto, Zanotelli, Maria Lúcia, Cantisani, Guido, Brandão, Ajácio B M
• Format: Article
• Language: English
• Subjects: Adult; Biomarkers - blood; Cirrhosis; Creatinine - blood; Female; Gender; Glomerular Filtration Rate; Health Status Indicators; Healthcare Disparities; Humans; Kaplan-Meier Estimate; Kidney - physiopathology; Liver Cirrhosis - blood; Liver Cirrhosis - diagnosis; Liver Cirrhosis - mortality; Liver Cirrhosis - physiopathology; Liver Cirrhosis - surgery; Liver Transplantation; Male; MDRD; Middle Aged; Patient Selection; Registries; Risk Factors; Severity of Illness Index; Sex Factors; Time Factors; Waiting Lists - mortality
• ISSN: 1665-2681
• DOI: 10.1016/S1665-2681(19)31006-3

A systematic bias against women, resulting from the use of creatinine as a measure of renal function, has been identified in Model for End-stage Liver Disease (MELD)-based liver allocation. Correction of this bias by calculation of female creatinine levels using the Modification of Diet in Renal Disease (MDRD) formula has been suggested. A cohort of 639 cirrhotic candidates for first-time liver transplantation was studied. Creatinine levels were corrected for gender using the MDRD formula. The accuracy of MELD, with or without creatinine correction, to predict 3-and 6-month mortality after inclusion in a transplant waiting list was estimated. Women exhibited significantly lower creatinine levels, glomerular filtration rate, and MELD scores than men. After creatinine correction, female MELD scores had a mean increase of 1.1 points. Creatinine correction yielded an increase of 3 points in the MELD score in 15.2% of patients, 2 points in 22.4%, and 1 point in 17.6% of patients. The likelihood of death at 3 and 6 months after enrollment in the transplant waiting list was similar in males and females and the likelihood of receiving a transplant, as assessed by Kaplan-Meier survival curves, was also similar in males and females. The survival or the likelihood of receiving a transplant while on the waiting list were similar in men and women in both pre- and post-MELD eras and creatinine correction did not increase the accuracy of the MELD score in estimating 3- and 6-month mortality in female candidates for liver transplantation.