{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T07:02:41Z","timestamp":1779692561795,"version":"3.53.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Transplant."],"abstract":"<jats:sec>\n                    <jats:title>Background &amp;amp; aims<\/jats:title>\n                    <jats:p>As a response to the well-documented disadvantages within the current allocation system, MELD 3.0 emerged on July 15, 2023, to more accurately characterize end-stage liver disease severity across the sexes. While simulation modeling predicted fewer waitlist deaths compared to MELD-Na, there is a lack of empirical data evaluating the efficacy of MELD 3.0 since its implementation. This study aims to conduct a waitlist patient survival study to explore sex- and age-based survival disparities in women and quantify empirical survival differences among waitlisted liver transplant candidates before and after the implementation of MELD 3.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective, cross-sectional patient risk analysis of the Scientific Registry of Transplant Recipients (SRTR) database of liver transplant candidates listed from January 1, 2017, to September 3, 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Adult liver transplant candidates on the waitlist (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200995, 211). Exclusion criteria included a history of prior transplant and the need for multi-organ transplant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>All-cause patient waitlist mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcomes and measures<\/jats:title>\n                    <jats:p>The primary outcome was the persistence of the waitlist survival gap between the sexes before and after the implementation of MELD 3.0. Secondary outcomes included risk-adjusted survival disparities in association with age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across the two MELD eras, waitlisted females experienced a 16.28% mean increase in the relative 180-day median hazard ratio as compared to males. Patients 65 years and older had a 350% mean increase in their 180-day mortality hazard ratio as compared to patients 18 to 35 years of age. Patients 65 years of age and older with MELD scores greater than 34 experienced a 180-day median survival probability of 65%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and relevance<\/jats:title>\n                    <jats:p>Despite the implementation of MELD 3.0, the waitlist survival gap disadvantaging women persists. The relationships between waitlist survival and patient age and sex are complex and time-dependent. As such, time-dependent survival models along with the addition of patient age and other characteristics could significantly improve patient survival diagnostics and help close the waitlist survival gap between the sexes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frtra.2026.1755115","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:04:43Z","timestamp":1779689083000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex-based survival disparities persist in liver transplantation: MELD 3.0 fails to improve survival for waitlisted women"],"prefix":"10.3389","volume":"5","author":[{"given":"Marissa","family":"Di Napoli","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Transplant Surgery, Anschutz Medical Campus, University of Colorado","place":["Aurora, CO, United 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Colorado","place":["Aurora, CO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryon","family":"Bhagwandin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Transplant Surgery, Anschutz Medical Campus, University of Colorado","place":["Aurora, CO, United States"]},{"name":"Colorado Center for Transplantation Care, Research and Education, Anschutz Medical Campus, University of Colorado","place":["Aurora, CO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Transplant Surgery, Anschutz Medical Campus, University of Colorado","place":["Aurora, CO, United States"]},{"name":"Colorado Center for Transplantation Care, Research and Education, Anschutz Medical Campus, University of Colorado","place":["Aurora, CO, United States"]},{"name":"Department of Medicine, Anschutz Medical Campus, University of Colorado","place":["Aurora, CO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Malamon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Transplant Surgery, Anschutz Medical Campus, University of Colorado","place":["Aurora, CO, United States"]},{"name":"Colorado Center for Transplantation Care, Research and Education, Anschutz Medical Campus, University of Colorado","place":["Aurora, CO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1053\/jhep.2001.22172","article-title":"A model to predict survival in patients with end-stage liver 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