Re: Women less likely to get liver transplant with MELD score

[Guest guest]

True,PSE patients get the shaft by thr MELD. The Meld will not cosiders

the horrors of full blown, body-wide, 24/4 pruritis (horrible intternal

itching) as an exception. These patients may never get a transplant

because the MELD considers uncurable pruritis as a quality of life

matter.

The reason that I can see for a higher transplant rate for males, is

that men drink more.

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[Guest guest]

The written report, " Disparities in Liver Transplant Allocation Shift

but Still Exist " , at:

http://www.medpagetoday.com/Gastroenterology/LiverTransplantation/11918

speculates that the reason is that women are at a disadvantage because

of their generally smaller size than men. They write, " because women

have less body mass, the inclusion of creatinine rather than

weight-adjusted glomerular filtration rate in the MELD score is likely

to underestimate their degree of renal dysfunction. " Also, small

livers are prioritized for pediatric transplantation and although a

small liver may be used for a large person, large liver are not

appropriate for a person with a small build. So on average fewer are

available for transplantion in women.

I disagree that PSCers are at a disadvantage with MELD. The statistic

don't support that statement. The death rate for those on the waiting

list for cholestatic liver disease (mostly PSC and PBC) is much below

average (77.1 vs 116.8 per 1,000 Patient-Years at Risk in 2006). Lower

than any other diagnostic category except biliary atresia. It is true

that pruritis is not taken into account by the MELD score, but all

liver disease patients are at risk of suffering from pruritis. It is

not just a PSC problem. And once we receive a transplant our survival

is among the best of all the diagnostic categories. (See Reported

Deaths on Liver Waiting List at

http://www.optn.org/AR2007/903_can-dgn_li.htm).

Tim R

[Guest guest]

I think if they looked at transplants for those less than 120 lb or

more than 120 lb the same sort of effect would be seen. But more women

fall in the under 120 range than men, so it shows up as affecting

women when the analysis is by gender. Still it is something that

should be accounted for and corrected in the MELD score computation /

allocation policy.

It is somewhat a factor of how we look for discrimination - by gender,

race, left handed vs. right handed, hair color, eye color, size,

country of origin, ethnic background, financial status? Some of these

present obstacles at different points in accessing medical care. The

waiting list to transplant link is probably one of the most bias free

steps in the process (IMHO).

Tim R

>

> Tim

> Thank you for a voice of reason.? It is so easy to get upset about

such issues and neglect getting all the information.? Women are not

geting fewer liver transplants because they are women, it is an issue

of physical size.?

> Take care

> MizKit

>

>

> Re: Women less likely to get liver transplant

with MELD score

>

> The written report, " Disparities in Liver Transplant Allocation Shift

> but Still Exist " , at:

> http://www.medpagetoday.com/Gastroenterology/LiverTransplantation/11918

> speculates that the reason is that women are at a disadvantage because

> of their generally smaller size than men. ...

[Guest guest]

I think if they looked at transplants for those less than 120 lb or

more than 120 lb the same sort of effect would be seen. But more women

fall in the under 120 range than men, so it shows up as affecting

women when the analysis is by gender. Still it is something that

should be accounted for and corrected in the MELD score computation /

allocation policy.

It is somewhat a factor of how we look for discrimination - by gender,

race, left handed vs. right handed, hair color, eye color, size,

country of origin, ethnic background, financial status? Some of these

present obstacles at different points in accessing medical care. The

waiting list to transplant link is probably one of the most bias free

steps in the process (IMHO).

Tim R

>

> Tim

> Thank you for a voice of reason.? It is so easy to get upset about

such issues and neglect getting all the information.? Women are not

geting fewer liver transplants because they are women, it is an issue

of physical size.?

> Take care

> MizKit

>

>

> Re: Women less likely to get liver transplant

with MELD score

>

> The written report, " Disparities in Liver Transplant Allocation Shift

> but Still Exist " , at:

> http://www.medpagetoday.com/Gastroenterology/LiverTransplantation/11918

> speculates that the reason is that women are at a disadvantage because

> of their generally smaller size than men. ...