Re: Meld? and Getting Listed/MELD sex discrimination

[Guest guest]

You need to know your MELD. You need your birthday, INR, and bili, and

creatinine to plug into the formula.

http://www.unos.org/resources/meldPeldCalculator.asp

If you don't have your labs printed and with you, you could call the

lab or Dr. office to get them. The best doctors prefer patients that

are engaged in fighting their illness so Dr. Laurin would welcome

giving you the information.

If your MELD is below 15 then you would not be considered sick enough

to get a scarce cadaveric liver and so it might be a waste of effort

to be on the list if lower than 15.

There is no way to transplant the ducts because all the ducts in the

liver are involved and most of the ducts are micrscopic.

By the way, I think that the MELD discriminates against women because

they naturally have lower bilirubin levels. Normal male is .6, normal

female .8 If this 25% difference extended to abnormal level then a

man's MELD would be higher.

>

> My doctor is Dr. Laurin (female) supposedly " the " best

> liver specialist in my area (DC/Baltimore) even better than at

> Hopkins per other doctors... but again, I still don't know what a

> meld test is ... maybe I missed the explanation--- my " numbers "

> aren't terrible, mostly elevated liver enzymes, but the ERCP showed

> the blockages (which have been present since 98) ... and I'm

> incredibly fatigued, no stamina (trying to get disability, what fun

> that is!) ... if in fact I could get on a list at this point in

> time, how does one even " get on a list " or where, my doc is saying

> since I don't have cirhosis and my numbers aren't REALLY high I'm

> not eligible - she says when they get into the several hundreds,

> thousands for liver enzymes then yes, right now it's like 350 or so

> for AST I believe.

>

> Has anyone got on a list with a similar situation ...

>

> (is there such thing as tranplanting the ducts, or always the whole

> liver - since my liver so far is seemingly okay - but it sure

> doesn't FEEL that way since it's tender and sluggish -)

>

>

[Guest guest]

>> By the way, I think that the MELD discriminates against women because

> they naturally have lower bilirubin levels. Normal male is .6, normal

> female .8 If this 25% difference extended to abnormal level then a

> man's MELD would be higher.

>

What????

As much as I should let this one go there is just no basis in fact for

this conclusion. First of all there is no normal bilirubin level for

anyone that specific. That is why when you look at your lab results

there is a range of normal typically between .3 and 1.3. Woman A's

normal might be .6, Man A's normal might be .8 but than Woman B's

normal might be .9 and Man B's normal might .4. The point is this

varies by individual, lab, time of day, what you ate, etc.

Secondly, even if there was a difference that difference will not

follow a linear pattern into the abnormal range and the difference

would have very little impact on MELD score. In fact if you look at

the effect bilirubin has on overall MELD score it is the least weighted

of all the values in the calculation. No study I am aware of has ever

drawn any conclusion along the lines of what you are suggesting. I

think it is not right to make such statements without basing them on

some sort of statistical fact in a forum such as this.

in Seattle

P.S. Sorry if this seems harsh but I just find it really frustrating

when statements are made and conclusions are drawn without checking the

facts first. The statements about MELD being biased against PSC

patients is another example. New people here just learning don't know

how to seperate fact from fiction.

[Guest guest]

>> By the way, I think that the MELD discriminates against women because

> they naturally have lower bilirubin levels. Normal male is .6, normal

> female .8 If this 25% difference extended to abnormal level then a

> man's MELD would be higher.

>

What????

As much as I should let this one go there is just no basis in fact for

this conclusion. First of all there is no normal bilirubin level for

anyone that specific. That is why when you look at your lab results

there is a range of normal typically between .3 and 1.3. Woman A's

normal might be .6, Man A's normal might be .8 but than Woman B's

normal might be .9 and Man B's normal might .4. The point is this

varies by individual, lab, time of day, what you ate, etc.

Secondly, even if there was a difference that difference will not

follow a linear pattern into the abnormal range and the difference

would have very little impact on MELD score. In fact if you look at

the effect bilirubin has on overall MELD score it is the least weighted

of all the values in the calculation. No study I am aware of has ever

drawn any conclusion along the lines of what you are suggesting. I

think it is not right to make such statements without basing them on

some sort of statistical fact in a forum such as this.

in Seattle

P.S. Sorry if this seems harsh but I just find it really frustrating

when statements are made and conclusions are drawn without checking the

facts first. The statements about MELD being biased against PSC

patients is another example. New people here just learning don't know

how to seperate fact from fiction.

[Guest guest]

> ... MELD discriminates against women because

> they naturally have lower bilirubin levels. Normal male is .6, normal

> female .8 If this 25% difference extended to abnormal level then

a

> man's MELD would be higher.

I too would like to know where you found information on a gender

difference in bilirubin. I would be more accepting of a difference in

creatinine, because men with their larger muscle mass tend to have

higher creatinine levels.

The impact of such a difference in bilirubin on MELD is minor. If the

difference of 25% continued as bilirubin rose it would contribute 0.84

(just under one point) to the difference in MELD score. If the

bilirubin difference stayed at a constant 0.2 mg/dl then at a

bilirubin of 5.0 the MELD difference would be 0.15 at 10.0 it would be

down to 0.07, insignificant when you consider that MELD is rounded to

the nearest whole number.

Tim R

[Guest guest]

> ... MELD discriminates against women because

> they naturally have lower bilirubin levels. Normal male is .6, normal

> female .8 If this 25% difference extended to abnormal level then

a

> man's MELD would be higher.

I too would like to know where you found information on a gender

difference in bilirubin. I would be more accepting of a difference in

creatinine, because men with their larger muscle mass tend to have

higher creatinine levels.

The impact of such a difference in bilirubin on MELD is minor. If the

difference of 25% continued as bilirubin rose it would contribute 0.84

(just under one point) to the difference in MELD score. If the

bilirubin difference stayed at a constant 0.2 mg/dl then at a

bilirubin of 5.0 the MELD difference would be 0.15 at 10.0 it would be

down to 0.07, insignificant when you consider that MELD is rounded to

the nearest whole number.

Tim R

[Guest guest]

> ... MELD discriminates against women because

> they naturally have lower bilirubin levels. Normal male is .6, normal

> female .8 If this 25% difference extended to abnormal level then

a

> man's MELD would be higher.

I too would like to know where you found information on a gender

difference in bilirubin. I would be more accepting of a difference in

creatinine, because men with their larger muscle mass tend to have

higher creatinine levels.

The impact of such a difference in bilirubin on MELD is minor. If the

difference of 25% continued as bilirubin rose it would contribute 0.84

(just under one point) to the difference in MELD score. If the

bilirubin difference stayed at a constant 0.2 mg/dl then at a

bilirubin of 5.0 the MELD difference would be 0.15 at 10.0 it would be

down to 0.07, insignificant when you consider that MELD is rounded to

the nearest whole number.

Tim R

[Guest guest]

All this talk about the MELD and gender caused me to just out of

curiousity put in Todd's numbers to see what his MELD would be from

his last labs. I have a couple of questions that maybe someone with

more MELD knowledge could answer. Is the Serum Creatinine the same

on

the lab results as Creatinine or is this a different test that is

done?

Also I think it is very important to note that there are other

things that can be affecting your MELD. The reason I say this is

because Todd's MELD (as long as the Creatinine and the Serum

Creatinine are one in the same) right now is 18. That is the same

MELD he had when he was transplanted 2 1/2 years ago. But the

reason

his MELD is registering that high is because of the new (developed

in

the last 8 months) blood disorder that is causing his INR to be

high. If I would have checked his MELD before his INR was affected

his MELD would have been within normal ranges.

Together in the fight...Whatever it Takes!!!

Joanne (mom of Todd, 20, psc 01, crohns 02, tx twice 03, recurrent

psc

05, living life to the fullest 06, lost 9 lbs in the last 5 months

that is causing me some concern, but we are waiting for the new lab

reports for a hopeful explanation)

[Guest guest]

Hey, I'm new to this list and didn't intend to cause any confusion. I

enjoy the discussion of ideas and science on this list as much as the

personal aspects.

I just found it facinating that the average healthy female bilirubin

was .6 and average healthy bilirubin for males was .8. I don't think

anyone has figured out why there is a difference. And probably no one

has figured out if there are differences in disease states. But IF

the 25% extrapolated in PSC then a bili of 12 in a woman might be

comparable to an 16 in a man which could make a MELD differnce and

could make a transplant difference.

My point of view is that MELD is an imperfect tool. (Any reader

looking for basic information can move to the next message as this is

just opinion) It's better than nothing and better than using a

single test but is not perfect. The 3 lab tests in the MELD can vary

based on factors other than liver health. Creatine changes based on

hydration, medication, the presence of congestive heart failure, and

muscle mass. As liver failure develops muscle mass drops and the

creatine production drops which would move the MELD lower. The bili

can vary based on many things like you and Barbara mentioned. The INR

can change based on medications, and dietary vit K. Which could have

nothing to do with liver health. The MELD is supposed to estimate

liver health across different liver diseases. The problem is that the

type of liver disease might effect these lab values. Cholestatic

disease like PSC and PBC might cause earlier and higher bilirubin

elevations. Choestatic diseases also can cause Vit K malabsorbion and

elevate the IRN more. Alcoholic and hepititis liver failure is more

likely to have elevated creatine in the end stage.

Some day a better model could be developed. There is discussion about

adding sodium levels. Pehaps some day there will be enough information

to adjust for male/female differences. If UNOS mined their data and

found more females dying on the waiting list then it would be worth

studing.

> >> By the way, I think that the MELD discriminates against women because

> > they naturally have lower bilirubin levels. Normal male is .6, normal

> > female .8 If this 25% difference extended to abnormal level then a

> > man's MELD would be higher.

> >

>

> What????

>

> As much as I should let this one go there is just no basis in fact for

> this conclusion. First of all there is no normal bilirubin level for

> anyone that specific. That is why when you look at your lab results

> there is a range of normal typically between .3 and 1.3. Woman A's

> normal might be .6, Man A's normal might be .8 but than Woman B's

> normal might be .9 and Man B's normal might .4. The point is this

> varies by individual, lab, time of day, what you ate, etc.

>

> Secondly, even if there was a difference that difference will not

> follow a linear pattern into the abnormal range and the difference

> would have very little impact on MELD score. In fact if you look at

> the effect bilirubin has on overall MELD score it is the least weighted

> of all the values in the calculation. No study I am aware of has ever

> drawn any conclusion along the lines of what you are suggesting. I

> think it is not right to make such statements without basing them on

> some sort of statistical fact in a forum such as this.

>

> in Seattle

>

> P.S. Sorry if this seems harsh but I just find it really frustrating

> when statements are made and conclusions are drawn without checking the

> facts first. The statements about MELD being biased against PSC

> patients is another example. New people here just learning don't know

> how to seperate fact from fiction.

>

[Guest guest]

Hey, I'm new to this list and didn't intend to cause any confusion. I

enjoy the discussion of ideas and science on this list as much as the

personal aspects.

I just found it facinating that the average healthy female bilirubin

was .6 and average healthy bilirubin for males was .8. I don't think

anyone has figured out why there is a difference. And probably no one

has figured out if there are differences in disease states. But IF

the 25% extrapolated in PSC then a bili of 12 in a woman might be

comparable to an 16 in a man which could make a MELD differnce and

could make a transplant difference.

My point of view is that MELD is an imperfect tool. (Any reader

looking for basic information can move to the next message as this is

just opinion) It's better than nothing and better than using a

single test but is not perfect. The 3 lab tests in the MELD can vary

based on factors other than liver health. Creatine changes based on

hydration, medication, the presence of congestive heart failure, and

muscle mass. As liver failure develops muscle mass drops and the

creatine production drops which would move the MELD lower. The bili

can vary based on many things like you and Barbara mentioned. The INR

can change based on medications, and dietary vit K. Which could have

nothing to do with liver health. The MELD is supposed to estimate

liver health across different liver diseases. The problem is that the

type of liver disease might effect these lab values. Cholestatic

disease like PSC and PBC might cause earlier and higher bilirubin

elevations. Choestatic diseases also can cause Vit K malabsorbion and

elevate the IRN more. Alcoholic and hepititis liver failure is more

likely to have elevated creatine in the end stage.

Some day a better model could be developed. There is discussion about

adding sodium levels. Pehaps some day there will be enough information

to adjust for male/female differences. If UNOS mined their data and

found more females dying on the waiting list then it would be worth

studing.

> >> By the way, I think that the MELD discriminates against women because

> > they naturally have lower bilirubin levels. Normal male is .6, normal

> > female .8 If this 25% difference extended to abnormal level then a

> > man's MELD would be higher.

> >

>

> What????

>

> As much as I should let this one go there is just no basis in fact for

> this conclusion. First of all there is no normal bilirubin level for

> anyone that specific. That is why when you look at your lab results

> there is a range of normal typically between .3 and 1.3. Woman A's

> normal might be .6, Man A's normal might be .8 but than Woman B's

> normal might be .9 and Man B's normal might .4. The point is this

> varies by individual, lab, time of day, what you ate, etc.

>

> Secondly, even if there was a difference that difference will not

> follow a linear pattern into the abnormal range and the difference

> would have very little impact on MELD score. In fact if you look at

> the effect bilirubin has on overall MELD score it is the least weighted

> of all the values in the calculation. No study I am aware of has ever

> drawn any conclusion along the lines of what you are suggesting. I

> think it is not right to make such statements without basing them on

> some sort of statistical fact in a forum such as this.

>

> in Seattle

>

> P.S. Sorry if this seems harsh but I just find it really frustrating

> when statements are made and conclusions are drawn without checking the

> facts first. The statements about MELD being biased against PSC

> patients is another example. New people here just learning don't know

> how to seperate fact from fiction.

>

[Guest guest]

Hey, I'm new to this list and didn't intend to cause any confusion. I

enjoy the discussion of ideas and science on this list as much as the

personal aspects.

I just found it facinating that the average healthy female bilirubin

was .6 and average healthy bilirubin for males was .8. I don't think

anyone has figured out why there is a difference. And probably no one

has figured out if there are differences in disease states. But IF

the 25% extrapolated in PSC then a bili of 12 in a woman might be

comparable to an 16 in a man which could make a MELD differnce and

could make a transplant difference.

My point of view is that MELD is an imperfect tool. (Any reader

looking for basic information can move to the next message as this is

just opinion) It's better than nothing and better than using a

single test but is not perfect. The 3 lab tests in the MELD can vary

based on factors other than liver health. Creatine changes based on

hydration, medication, the presence of congestive heart failure, and

muscle mass. As liver failure develops muscle mass drops and the

creatine production drops which would move the MELD lower. The bili

can vary based on many things like you and Barbara mentioned. The INR

can change based on medications, and dietary vit K. Which could have

nothing to do with liver health. The MELD is supposed to estimate

liver health across different liver diseases. The problem is that the

type of liver disease might effect these lab values. Cholestatic

disease like PSC and PBC might cause earlier and higher bilirubin

elevations. Choestatic diseases also can cause Vit K malabsorbion and

elevate the IRN more. Alcoholic and hepititis liver failure is more

likely to have elevated creatine in the end stage.

Some day a better model could be developed. There is discussion about

adding sodium levels. Pehaps some day there will be enough information

to adjust for male/female differences. If UNOS mined their data and

found more females dying on the waiting list then it would be worth

studing.

> >> By the way, I think that the MELD discriminates against women because

> > they naturally have lower bilirubin levels. Normal male is .6, normal

> > female .8 If this 25% difference extended to abnormal level then a

> > man's MELD would be higher.

> >

>

> What????

>

> As much as I should let this one go there is just no basis in fact for

> this conclusion. First of all there is no normal bilirubin level for

> anyone that specific. That is why when you look at your lab results

> there is a range of normal typically between .3 and 1.3. Woman A's

> normal might be .6, Man A's normal might be .8 but than Woman B's

> normal might be .9 and Man B's normal might .4. The point is this

> varies by individual, lab, time of day, what you ate, etc.

>

> Secondly, even if there was a difference that difference will not

> follow a linear pattern into the abnormal range and the difference

> would have very little impact on MELD score. In fact if you look at

> the effect bilirubin has on overall MELD score it is the least weighted

> of all the values in the calculation. No study I am aware of has ever

> drawn any conclusion along the lines of what you are suggesting. I

> think it is not right to make such statements without basing them on

> some sort of statistical fact in a forum such as this.

>

> in Seattle

>

> P.S. Sorry if this seems harsh but I just find it really frustrating

> when statements are made and conclusions are drawn without checking the

> facts first. The statements about MELD being biased against PSC

> patients is another example. New people here just learning don't know

> how to seperate fact from fiction.

>

[Guest guest]

> I just found it facinating that the average healthy female bilirubin

> was .6 and average healthy bilirubin for males was .8. I don't

think

> anyone has figured out why there is a difference. And probably no

one

> has figured out if there are differences in disease states. But IF

> the 25% extrapolated in PSC then a bili of 12 in a woman might be

> comparable to an 16 in a man which could make a MELD differnce and

> could make a transplant difference.

>

> My point of view is that MELD is an imperfect tool. (Any reader

> looking for basic information can move to the next message as this

is

> just opinion) It's better than nothing and better than using a

> single test but is not perfect. The 3 lab tests in the MELD can vary

> based on factors other than liver health. Creatine changes based on

> hydration, medication, the presence of congestive heart failure, and

> muscle mass. As liver failure develops muscle mass drops and the

> creatine production drops which would move the MELD lower. The bili

> can vary based on many things like you and Barbara mentioned. The

INR

> can change based on medications, and dietary vit K. Which could have

> nothing to do with liver health. The MELD is supposed to estimate

> liver health across different liver diseases. The problem is that

the

> type of liver disease might effect these lab values. Cholestatic

> disease like PSC and PBC might cause earlier and higher bilirubin

> elevations. Choestatic diseases also can cause Vit K malabsorbion

and

> elevate the IRN more. Alcoholic and hepititis liver failure is more

> likely to have elevated creatine in the end stage.

> Some day a better model could be developed. There is discussion

about

> adding sodium levels. Pehaps some day there will be enough

information

> to adjust for male/female differences. If UNOS mined their data and

> found more females dying on the waiting list then it would be worth

> studing.

>

>

So as Tim pointed out, even granting your assumption that the 25%

difference carries through into abnormal range the difference in MELD

would on be 1 point. Plugging the numbers you suggested 12 for

Female and 16 for Male and assuuming other lab numbers being normal

generates a MELD of 16 for the female and 17 for the male. Not a

significant difference. In regards to death rates, go to the website

I have listed below and you will see death rate shows the opposite

result with the death rate for females being consistently lower than

for that of males.

http://www.optn.org/AR2005/903_can-gender_li.htm

Ther is no perfect tool for organ allocation because every person,

every disease, every situation is different. You will never be able

to develop a model that takes all variables into account. All you

can do is take your best shot based on scientific data and fact. As

we learn more perhaps there will be minor tweaks to the system but I

would not hold your breath for any real significant changes to the

system. Sorry again if I came across too harsh but we need to be

careful when drawing such conclusions and generalizations. As you

cans ee from the statistics on the website above your conclusion was

exactly opposite of what the true statistics support.

in Seattle

[Guest guest]

> I just found it facinating that the average healthy female bilirubin

> was .6 and average healthy bilirubin for males was .8. I don't

think

> anyone has figured out why there is a difference. And probably no

one

> has figured out if there are differences in disease states. But IF

> the 25% extrapolated in PSC then a bili of 12 in a woman might be

> comparable to an 16 in a man which could make a MELD differnce and

> could make a transplant difference.

>

> My point of view is that MELD is an imperfect tool. (Any reader

> looking for basic information can move to the next message as this

is

> just opinion) It's better than nothing and better than using a

> single test but is not perfect. The 3 lab tests in the MELD can vary

> based on factors other than liver health. Creatine changes based on

> hydration, medication, the presence of congestive heart failure, and

> muscle mass. As liver failure develops muscle mass drops and the

> creatine production drops which would move the MELD lower. The bili

> can vary based on many things like you and Barbara mentioned. The

INR

> can change based on medications, and dietary vit K. Which could have

> nothing to do with liver health. The MELD is supposed to estimate

> liver health across different liver diseases. The problem is that

the

> type of liver disease might effect these lab values. Cholestatic

> disease like PSC and PBC might cause earlier and higher bilirubin

> elevations. Choestatic diseases also can cause Vit K malabsorbion

and

> elevate the IRN more. Alcoholic and hepititis liver failure is more

> likely to have elevated creatine in the end stage.

> Some day a better model could be developed. There is discussion

about

> adding sodium levels. Pehaps some day there will be enough

information

> to adjust for male/female differences. If UNOS mined their data and

> found more females dying on the waiting list then it would be worth

> studing.

>

>

So as Tim pointed out, even granting your assumption that the 25%

difference carries through into abnormal range the difference in MELD

would on be 1 point. Plugging the numbers you suggested 12 for

Female and 16 for Male and assuuming other lab numbers being normal

generates a MELD of 16 for the female and 17 for the male. Not a

significant difference. In regards to death rates, go to the website

I have listed below and you will see death rate shows the opposite

result with the death rate for females being consistently lower than

for that of males.

http://www.optn.org/AR2005/903_can-gender_li.htm

Ther is no perfect tool for organ allocation because every person,

every disease, every situation is different. You will never be able

to develop a model that takes all variables into account. All you

can do is take your best shot based on scientific data and fact. As

we learn more perhaps there will be minor tweaks to the system but I

would not hold your breath for any real significant changes to the

system. Sorry again if I came across too harsh but we need to be

careful when drawing such conclusions and generalizations. As you

cans ee from the statistics on the website above your conclusion was

exactly opposite of what the true statistics support.

in Seattle

[Guest guest]

> My point of view is that MELD is an imperfect tool.

AMEN to that! Some complications, not necessarily specific to PSC,

are not taken into account by MELD, but carry a high risk of death.

Recurrent bacterial cholangitis, which carries a risk of sepsis, can

be be deadly even when there is no cirrhosis. Variceal bleeds can be

life-threatening and may occur when MELD is low. Additional points can

be added by the UNOS regional review boards for these factors; some

regions are more flexible than others. UNOS put out some proposed new

guidelines, to award points for additional problems, but these have

not yet been adopted.

Other organ allocation systems are very different. In kidney, it is

primarily waiting time. Dialysis makes it possible to survive a long

wait for a kidney, not that everyone does.

> Creatine changes based on

> hydration, medication, the presence of congestive heart failure, and

> muscle mass. As liver failure develops muscle mass drops and the

> creatine production drops which would move the MELD lower.

For non-medical readers, I just wanted to clarify that creatine and

creatinine are related but distinct. Creatine is an important

substance in muscle. Creatinine is a breakdown product of creatine

that is normally excreted by kidney. In renal failure creatinine goes

up in blood. I hadn't considered the loss of muscle counterbalancing

renal failure, or the influence of congestive heart failure either.

Though if you had CHF, would you still be a candidate for liver

transplant?

Some of our readers have also found that when they were prescribed

blood thinners like coumadin/warfarin it increased their MELD enough

to be given a cadaveric liver.

So MELD isn't exactly fair, but it's fairer in a way than what came

before.

Martha (MA)

[Guest guest]

> My point of view is that MELD is an imperfect tool.

AMEN to that! Some complications, not necessarily specific to PSC,

are not taken into account by MELD, but carry a high risk of death.

Recurrent bacterial cholangitis, which carries a risk of sepsis, can

be be deadly even when there is no cirrhosis. Variceal bleeds can be

life-threatening and may occur when MELD is low. Additional points can

be added by the UNOS regional review boards for these factors; some

regions are more flexible than others. UNOS put out some proposed new

guidelines, to award points for additional problems, but these have

not yet been adopted.

Other organ allocation systems are very different. In kidney, it is

primarily waiting time. Dialysis makes it possible to survive a long

wait for a kidney, not that everyone does.

> Creatine changes based on

> hydration, medication, the presence of congestive heart failure, and

> muscle mass. As liver failure develops muscle mass drops and the

> creatine production drops which would move the MELD lower.

For non-medical readers, I just wanted to clarify that creatine and

creatinine are related but distinct. Creatine is an important

substance in muscle. Creatinine is a breakdown product of creatine

that is normally excreted by kidney. In renal failure creatinine goes

up in blood. I hadn't considered the loss of muscle counterbalancing

renal failure, or the influence of congestive heart failure either.

Though if you had CHF, would you still be a candidate for liver

transplant?

Some of our readers have also found that when they were prescribed

blood thinners like coumadin/warfarin it increased their MELD enough

to be given a cadaveric liver.

So MELD isn't exactly fair, but it's fairer in a way than what came

before.

Martha (MA)

[Guest guest]

-----Original Message-----

jumputah

The MELD is supposed

to estimate liver

health across different liver diseases. The problem is that the type of liver disease

might effect these lab values. Cholestatic

disease like PSC and PBC might cause earlier and higher Bilirubin elevations.

Exactly why the old CTP

scoring system didn’t allow points for Bilirubin (for PSC & PBC)

until they reached 4.0, while others got points starting with a Bilirubin of 2.

-----Original Message-----

jasonsea

12 for Female and 16 for Male and assuuming other lab numbers

being normal generates a MELD of 16 for the female and 17 for the male.

Not a significant difference.

But….that could be a HUGE difference if it determined

who got a transplant first. Shauna

had 1 person, with one point higher ahead of her.

-----Original Message-----

jasonsea

In regards to death rates, go to the website I have listed below and

you will see death rate shows the opposite

result with the death rate for females being consistently lower than for that

of males.

But….wouldn’t we have to factor in the gender

differences in getting the disease in the first place? More men than women get PSC….I’m

not sure, but would “think” more men than women also have alcoholic

cirrhosis and Hep C. That could

account for the gender difference in death while listed, but not show the true

percentages, men vs. women couldn’t it?

I love it when y’all banter back & forth on any given

issue.….I learn so much from all of you, we have such smart people in

this group. Bet all the other

groups are jealous! Hey, maybe we

can rent you guys out for a day and raise money.

Barb in Texas

[Guest guest]

-----Original Message-----

jumputah

The MELD is supposed

to estimate liver

health across different liver diseases. The problem is that the type of liver disease

might effect these lab values. Cholestatic

disease like PSC and PBC might cause earlier and higher Bilirubin elevations.

Exactly why the old CTP

scoring system didn’t allow points for Bilirubin (for PSC & PBC)

until they reached 4.0, while others got points starting with a Bilirubin of 2.

-----Original Message-----

jasonsea

12 for Female and 16 for Male and assuuming other lab numbers

being normal generates a MELD of 16 for the female and 17 for the male.

Not a significant difference.

But….that could be a HUGE difference if it determined

who got a transplant first. Shauna

had 1 person, with one point higher ahead of her.

-----Original Message-----

jasonsea

In regards to death rates, go to the website I have listed below and

you will see death rate shows the opposite

result with the death rate for females being consistently lower than for that

of males.

But….wouldn’t we have to factor in the gender

differences in getting the disease in the first place? More men than women get PSC….I’m

not sure, but would “think” more men than women also have alcoholic

cirrhosis and Hep C. That could

account for the gender difference in death while listed, but not show the true

percentages, men vs. women couldn’t it?

I love it when y’all banter back & forth on any given

issue.….I learn so much from all of you, we have such smart people in

this group. Bet all the other

groups are jealous! Hey, maybe we

can rent you guys out for a day and raise money.

Barb in Texas

[Guest guest]

>

> -----Original Message----- jasonsea

> 12 for Female and 16 for Male and assuuming other lab numbers being

> normal generates a MELD of 16 for the female and 17 for the male.

Not a

> significant difference.

>

> But..that could be a HUGE difference if it determined who got a

> transplant first. Shauna had 1 person, with one point higher ahead

of

> her.

>

This is accepting the theory that the difference between men and

women follow a linear pattern throughout which I still don't

believe. Once an abnormality causes values to elevate outside the

normal range I think this small difference would be canceled by the

disease causing the abnormality. It is a big stretch to assume the

25% difference carries throughout.

> -----Original Message----- jasonsea

> In regards to death rates, go to the website I have listed below

and you

> will see death rate shows the opposite

> result with the death rate for females being consistently lower

than for

> that of males.

>

> But..wouldn't we have to factor in the gender differences in

getting the

> disease in the first place? More men than women get PSC..I'm not

sure,

> but would " think " more men than women also have alcoholic cirrhosis

and

> Hep C. That could account for the gender difference in death while

> listed, but not show the true percentages, men vs. women couldn't

it?

>

Remember, this chart shows death rate per 1000 men or women that have

been listed. It has been awhile since I took statistics but this data

model should factor out the diffrence in number of people listed and

only look at the patients success once they have been listed per 1000

people. In other words if you look at 1000 men vs 1000 women, the

man is more likely to die prior to receiving a transplant.

in Seattle

[Guest guest]

> -----Original Message----- jasonsea

>> ... death rate shows the opposite

>> result with the death rate for females being consistently lower

than for

>> that of males.

>

> But..wouldn't we have to factor in the gender differences in getting the

> disease in the first place? More men than women get PSC..I'm not sure,

> but would " think " more men than women also have alcoholic cirrhosis and

> Hep C. That could account for the gender difference in death while

> listed, but not show the true percentages, men vs. women couldn't it?

http://www.optn.org/AR2005/903_can-gender_li.htm

The death rate accounts for the number of men and women waiting by

reporting the rate per 1,000 Patient-Years at Risk. What isn't

factored in is the MELD score. I did a rough analysis using the

assumption that the relative proportion of men and women in each MELD

range was the same in past years as it is now. (I have my doubts about

the validity of that assumption, because from 19945 to 2004 the female

patient-years at risk relative to the total decreased from 45% to 40%

and today only 30% of those waiting with MELD of 25+ are women). My

analysis of 2004 produced a lower over-all death rate for women, 118

to 130 but higher when MELD score was above 10. In the 11-18 range,

63.9 to 60.9; in the 19-24 range, 229.4 to 145.0; 25+, 1327 to 1207.

This suggests that a women with the same MELD as a man is more

critically ill. (Or that the present waiting list is a poor surogate

for the patient years at risk of prior years.) Assuming that women are

represented at 40% in each MELD category still gives a higher death

rate for women in the 19-24 range, while in all other ranges they do

better than men for 2004.

Tim R

[Guest guest]

> -----Original Message----- jasonsea

>> ... death rate shows the opposite

>> result with the death rate for females being consistently lower

than for

>> that of males.

>

> But..wouldn't we have to factor in the gender differences in getting the

> disease in the first place? More men than women get PSC..I'm not sure,

> but would " think " more men than women also have alcoholic cirrhosis and

> Hep C. That could account for the gender difference in death while

> listed, but not show the true percentages, men vs. women couldn't it?

http://www.optn.org/AR2005/903_can-gender_li.htm

The death rate accounts for the number of men and women waiting by

reporting the rate per 1,000 Patient-Years at Risk. What isn't

factored in is the MELD score. I did a rough analysis using the

assumption that the relative proportion of men and women in each MELD

range was the same in past years as it is now. (I have my doubts about

the validity of that assumption, because from 19945 to 2004 the female

patient-years at risk relative to the total decreased from 45% to 40%

and today only 30% of those waiting with MELD of 25+ are women). My

analysis of 2004 produced a lower over-all death rate for women, 118

to 130 but higher when MELD score was above 10. In the 11-18 range,

63.9 to 60.9; in the 19-24 range, 229.4 to 145.0; 25+, 1327 to 1207.

This suggests that a women with the same MELD as a man is more

critically ill. (Or that the present waiting list is a poor surogate

for the patient years at risk of prior years.) Assuming that women are

represented at 40% in each MELD category still gives a higher death

rate for women in the 19-24 range, while in all other ranges they do

better than men for 2004.

Tim R

[Guest guest]

Barb Henshaw wrote:

> 12 for Female and 16 for Male and assuuming other lab numbers being

> normal generates a MELD of 16 for the female and 17 for the male. Not

> a significant difference.

>

> -----Original Message----- jasonsea

>

> But….that could be a HUGE difference if it determined who got a

> transplant first. Shauna had 1 person, with one point higher ahead of her.

>

Sure it could be huge in it's consequences for an individual in some

circumstances, but I think what was saying was that it wasn't

statistically significant enough to separate out and make an adjustment

for. It also probably isn't significant enough to make a difference in

survival rates. What I mean is that we all wanted Shauna to get a

transplant, and it was very sad that she didn't get one, but there was

someone else who did get a transplant, and they probably had another

group of people pulling for them to get the transplant.

The real reason Shauna (and many others) didn't get transplants wasn't

some real or perceived bias in the system, but the organ donor shortage

in general. You can reshuffle the order of the wait list a thousand

different ways, and not effect the number of lives saved very much

because the maximum possible is related to the number of available

organs, not the order in which they're handed out.

> But….wouldn’t we have to factor in the gender differences in getting

> the disease in the first place?

>

In the web page that sent, there are more men listed than women

but the death rate is adjusted for the number of men or women in the

list.... it's the rate of death per 1000 patient years. In other words

if you had 1000 men on the list for a year then you'd expect 130.5 of

them to die (using the numbers for 2004). If you had 1000 women on the

list for a year, you'd expect 118.8 of them to die. That's a little bit

oversimplified, but it gives you the general idea.

So if there is a bias in the system that needs to be corrected, then the

numbers on this web page suggest that it's against men, not against

women. I'm not at all convinced that there is a bias... or at least not

that there is one that could be corrected in any meaningful way (I mean

we could just give men extra MELD points until their death rates are

equal to the women's death rates, but that's just an arbitrary

adjustment, not based on any real understanding of why the rates are

different, or if the difference actually indicated some degree of

unfairness).

That's my 2¢

athan

[Guest guest]

Barb Henshaw wrote:

> 12 for Female and 16 for Male and assuuming other lab numbers being

> normal generates a MELD of 16 for the female and 17 for the male. Not

> a significant difference.

>

> -----Original Message----- jasonsea

>

> But….that could be a HUGE difference if it determined who got a

> transplant first. Shauna had 1 person, with one point higher ahead of her.

>

Sure it could be huge in it's consequences for an individual in some

circumstances, but I think what was saying was that it wasn't

statistically significant enough to separate out and make an adjustment

for. It also probably isn't significant enough to make a difference in

survival rates. What I mean is that we all wanted Shauna to get a

transplant, and it was very sad that she didn't get one, but there was

someone else who did get a transplant, and they probably had another

group of people pulling for them to get the transplant.

The real reason Shauna (and many others) didn't get transplants wasn't

some real or perceived bias in the system, but the organ donor shortage

in general. You can reshuffle the order of the wait list a thousand

different ways, and not effect the number of lives saved very much

because the maximum possible is related to the number of available

organs, not the order in which they're handed out.

> But….wouldn’t we have to factor in the gender differences in getting

> the disease in the first place?

>

In the web page that sent, there are more men listed than women

but the death rate is adjusted for the number of men or women in the

list.... it's the rate of death per 1000 patient years. In other words

if you had 1000 men on the list for a year then you'd expect 130.5 of

them to die (using the numbers for 2004). If you had 1000 women on the

list for a year, you'd expect 118.8 of them to die. That's a little bit

oversimplified, but it gives you the general idea.

So if there is a bias in the system that needs to be corrected, then the

numbers on this web page suggest that it's against men, not against

women. I'm not at all convinced that there is a bias... or at least not

that there is one that could be corrected in any meaningful way (I mean

we could just give men extra MELD points until their death rates are

equal to the women's death rates, but that's just an arbitrary

adjustment, not based on any real understanding of why the rates are

different, or if the difference actually indicated some degree of

unfairness).

That's my 2¢

athan