Has Sex‐Based Disparity in Liver Transplantation Opportunities and Waitlist Mortality Improved in the MELD3.0 Era?: A Preliminary Study

BACKGROUND: In July 2023, the OPTN adopted MELD3.0 to address sex-based disparities in liver transplantation (LT) opportunity and waitlist mortality. No studies have proven that MELD3.0 alleviated them. METHODS: We evaluated sex-based disparities in LT opportunities and waitlist mortality, utilizing the UNOS data (August 2022-March 2024), comparing pre- and post-MELD3.0 eras. RESULTS: Among 11 795 LT candidates (pre-MELD3.0: 7263; post-MELD3.0: 4532), the proportion of females increased from 38.8% to 42.6% post-MELD3.0. In the transplanted population, females increased from 37.7% to 41.6% post-MELD3.0. The median MELD score difference ("MELD3.0-MELD-Na") at listing was -0.26 [-2.13, 0.80] for females and -0.86 [-2.92, 0.00] for males (p < 0.01). Compared to females, males consistently showed a larger drop in points from MELD-Na to MELD3.0. In the pre-MELD3.0 era, females had lower LT opportunity (sub-hazard ratio [sHR]: 0.88 [0.83-0.93], p < 0.01) and higher waitlist mortality (sHR: 1.39 [1.20-1.62], p < 0.01). In the post-MELD3.0 era, there were no significant differences in LT opportunity (sHR: 0.93 [0.87-1.00], p = 0.07) and waitlist mortality (sHR: 1.25 [0.98-1.57], p = 0.26). Subgroup analyses based on MELD-Na groups showed that significant differences in LT opportunity and waitlist mortality in the pre-MELD3.0 era became insignificant in the post-MELD3.0 era. Multivariable competing-risk analysis showed that, in the pre-MELD3.0 era, female sex was a significant risk factor for LT opportunity (sHR: 0.90 [0.84-0.96], p < 0.01) and waitlist mortality (sHR: 1.19 [1.01-1.38], p = 0.03), but in the post-MELD3.0 era, it was not significant (sHR: 0.94 [0.86-1.02], p = 0.11 for LT opportunity/sHR: 1.08 [0.83-1.40], p = 0.57 for waitlist mortality). CONCLUSIONS: Our preliminary findings suggest that MELD3.0 has the potential to reduce sex-based disparities in LT opportunities and waitlist mortality.