Impact of creatinine values on MELD scores in male and female candidates for liver transplantation
Journal Title: Annals of Hepatology - Year 2013, Vol 12, Issue 3
Abstract
[b]Introduction[/b]. 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. [b]Material and methods[/b]. A cohort of 639 cirrhotic candidates for firsttime 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. [b]Results[/b]. 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. [b]Conclusion[/b]. 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.
Authors and Affiliations
Guilherme Mariante-Neto Mariante-Neto, Caroline Marroni, Alfeu de Medeiros Fleck Junior, Cláudio Marroni, Maria Zanotelli,, Guido Cantisani, Ajácio Brandão
Keywords
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