Abstract：
In Eurotransplant, relatively more females than males die while waiting for liver transplantation, and relatively fewer females undergo transplantation. With adult liver transplantation candidates listed between 2007 and 2019 (n = 21 170), we study whether sex disparity is inherent to the model for end-stage liver disease (MELD) scoring system, or the indirect result of a small candidate body size limiting access to transplantation. Cox proportional hazard models are used to quantify the direct effect of sex on waitlist mortality, independent of the effect of sex through MELD scores, and the direct effect of sex on the transplantation rate, independent of the effect of sex through MELD and candidate body size. Adjusted waitlist mortality hazard ratios (HRs) for female sex are insignificant (HR: 1.03, 95% CI: 0.88-1.20). We thus lack evidence that MELD systematically underestimates waitlist mortality rates for females. Transplantation rates are 25% lower for females than males in unadjusted analyses (HR: 0.74, 95% CI: 0.71-0.77), but HRs become insignificant with adjustment for mediators (HR: 0.98, 95% CI: 0.93-1.04), most importantly candidate body size. Sex disparity in Eurotransplant thus appears to be largely a consequence of lower transplantation rates for females, which are explained by sex differences in body size.
摘要：
在欧洲移植中，在等待肝移植时死亡的女性相对多于男性，移植的雌性相对较少。在2007年至2019年之间列出了成人肝移植候选人（n=21,170），我们研究性别差异是否是终末期肝病模型（MELD）评分系统固有的，或小的候选体型限制移植的间接结果。Cox比例风险模型用于量化性别对候补死亡率的直接影响，通过MELD评分独立于性别的影响，以及性别对移植率的直接影响，通过MELD和候选体型独立于性别的影响。调整后的女性候补名单死亡率风险比微不足道（HR：1.03，95％-CI：0.88-1.20）。因此，我们缺乏证据表明MELD系统地低估了女性的候补死亡率。在未经调整的分析中，女性的移植率比男性低25%(HR:0.74,95%-CI:0.71-0.77)，但随着介体的调整，风险比变得微不足道(HR：0.98，95%-CI：0.93-1.04)，最重要的是候选人的体型。因此，欧洲移植中的性别差异似乎很大程度上是女性移植率较低的结果，这可以通过体型的性别差异来解释。
