Since the introduction of the MELD-based allocation system, women are now 30% less likely than men to undergo liver transplant (LT) and have 20% higher waitlist mortality. These disparities are in large part due to height differences in men and women though no national policies have been implemented to reduce sex disparities. Patients were identified using the Scientific Registry of Transplant Recipients (SRTR) from 2014 to 2019. Patients were categorized into five groups by first dividing into thirds by height then dividing the shortest third into three groups to capture more granular differences in the most disadvantaged patients (<166 cm). We then used LSAM to model waitlist outcomes in five versions of awarding additional MELD points to shorter candidates compared to current policy. We identified two proposed policy changes LSAM scenarios that resulted in improvement in LT and death percentage for the shortest candidates with the least negative impact on taller candidates. In conclusion, awarding an additional 1–2 MELD points to the shortest 8% of LT candidates would improve waitlist outcomes for women. This strategy should be considered in national policy allocation to address sex-based disparities in LT.

中文翻译：

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向最短的候补名单候选人授予额外的 MELD 积分可改善美国肝移植机会中的性别差异

自引入基于 MELD 的分配系统以来，女性现在接受肝移植 (LT) 的可能性比男性低 30%，候补死亡率高 20%。尽管尚未实施减少性别差异的国家政策，但这些差异在很大程度上是由于男女身高差异造成的。从 2014 年到 2019 年，使用移植接受者科学登记处 (SRTR) 确定了患者。患者被分为五组，首先按身高分成三分之一，然后将最矮的三分之一分成三组，以捕捉最弱势患者的更细微差异（ <166 厘米）。然后，我们使用 LSAM 对五个版本的候补名单结果进行建模，与当前政策相比，将额外的 MELD 积分授予较短的候选人。我们确定了两个拟议的政策变更 LSAM 情景，这些情景导致最矮候选人的 LT 和死亡率有所改善，而对较高候选人的负面影响最小。总之，向最短的 8% 的 LT 候选人额外奖励 1-2 MELD 点将改善女性候补名单的结果。在国家政策分配中应考虑这一战略，以解决 LT 中基于性别的差异。