More lives could be saved as Royal Free London research proven to eliminate gender bias
23 February 2023
New research shows that using a revised scoring system for offering livers for transplantation, which was developed by researchers at the Royal Free London and UCL, could lead to hundreds of lives being saved worldwide every year.
The study, published in The Lancet Gastroenterology & Hepatology journal, highlights that the current need based scoring system used by many healthcare systems across the world, is biased towards male recipients.
Furthermore, the results show that the new scoring method, developed by the Royal Free London and UCL and verified using 10 years worth of NHS transplantation data, would be a more accurate way to offer donor livers for both women and men, with one in eight deaths in women and 1 in 21 deaths overall being avoided for those on current transplant waiting lists worldwide. This could equate to hundreds of lives saved each year.
For those who develop complications of liver cirrhosis, the only available treatment is a liver transplant but the scarcity of available livers and the inherent risks in the procedure means it is vital to prioritise patients based on the severity of their liver disease.
An equation was developed to calculate the risk of a patient dying within three months. The higher the score, the greater the risk of dying and consequently the higher a patient is placed on the transplant list in order to increase their chance of receiving a liver in time.
The current equation used includes measuring levels of creatinine (a waste product from muscles) for renal function, as well as looking at jaundice levels and coagulation of the blood.
Professor Emmanouil Tsochatzis (pictured), a hepatology consultant, said: “What became evident over the years was that women were disadvantaged by the creatinine score because low levels of it is not an accurate measure of renal function in cirrhosis and women have less anyway because of their reduced muscle mass. In addition just because they have less of it does not mean their kidney function is less adversely affected than a man’s.
“Five years ago at the Royal Free Hospital we developed a formula to estimate glomerular filtration rate (eGFR), a blood test which provides a much better measurement of renal function, specifically in patients with cirrhosis and we named this the Royal Free Hospital cirrhosis GFR (RFH-GFR). The research, funded by the Royal Free Charity, was published. In this most recent study we have clearly demonstrated, via data from NHS Blood and Transplant, that by substituting RFH-GFR for the creatinine element of the existing allocation formula it would significantly improve risk prediction compared to the existing scores and importantly put a stop to disadvantaging women.”
In the UK many other factors are taken into consideration when deciding who should receive a liver, and the liver allocation score is merely used as guidance. However, the score is used much more extensively in the United States and other parts of Europe and it is there that Emmanouil believes it will have the most impact.
Emmanouil added: “I’m very proud of this research which has been five years of work. I believe it will change the way liver transplant patients are prioritised in several countries and potentially save many lives by helping those most in need of a liver receive it first.
“Many of the people who collaborated on this research were former fellows based at the Royal Free Hospital who are now working worldwide. Their input and collaboration was invaluable in delivering this study.”
Former Royal Free Hospital alumni and study co-authors included consultant hepatologists, Dr Marta Guerrero and Dr Avik Majumdar and associate professor and consultant hepatologist Dr Manuel Luis Rodriguez-Peralvarez.