Disparities in Liver Transplantation Before and After Introduction of the MELD Score
Moylan, Cynthia A.
Brady, Carla W.
Johnson, Jeffrey L.
Smith, Alastair D.
Tuttle-Newhall, Janet E.
Muir, Andrew J.
JAMA: The Journal of the American Medical Association 2008 November 26; 300(20): 2371-2378
Context: In February 2002, the allocation system for liver transplantation became based on the Model for End-Stage Liver Disease (MELD) score. Before MELD, black patients were more likely to die or become too sick to undergo liver transplantation compared with white patients. Little information exists regarding sex and access to liver transplantation. Objective; To determine the association between race, sex, and liver transplantation following introduction of the MELD system. Design, Setting, and Patients: A retrospective cohort of black and white patients (?18 years) registered on the United Network for Organ Sharing liver transplantation waiting list between January 1, 1996, and December 31, 2000 (pre-MELD cohort, n = 21 895) and between February 28, 2002, and March 31, 2006 (post-MELD cohort, n = 23 793). Main Outcome Measures: Association between race, sex, and receipt of a liver transplant. Separate multivariable analyses evaluated cohorts within each period to identify predictors of time to death and the odds of dying or receiving liver transplantation within 3 years of listing. Patients with hepatocellular carcinoma were analyzed separately. Results: Black patients were younger (mean [SD], 49.2 [10.7] vs 52.4 [9.2] years; P
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