| Title: |
Excluding Ascites From the GEMA ‐Na Score Does Not Impact Outcome Predictions in Liver Transplant Candidates |
| Authors: |
Rodríguez Perálvarez, Manuel Luis; Gómez Orellana, Antonio Manuel; Majumdar, Avik; Mccaughan, Geoffrey W.; Kalafateli, María; Taylor, Rhiannon; Rosa, Gloria de la; Victoria Aguilera, María; Gastaca, Mikel; Cepeda Franco, Carmen; Luisa Ortiz, María; Colmenero, Jordi; Otero, Alejandra; González Grande, Rocío; Cachero, Alba; Molina Pérez, Esther; Barreales, Mónica; Martín Mateos, Rosa; Rodríguez Soler, María; Romero, Mario; Dopazo, Cristina; Alonso Martín, Carmen; Otón, Elena; González Diéguez, Luisa; Dolores Espinosa, María; Arias Milla, Ana; Blanco Fernández, Gerardo; Lorente, Sara; Cuadrado Lavín, Antonio; Sogbe, Miguel; Guijo Rubio, David; Hervás Martínez, César; Tsochatzis, Emmanuel A. |
| Source: |
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
| Publisher Information: |
Wiley |
| Publication Year: |
2026 |
| Collection: |
Dipòsit Digital de la Universitat de Barcelona |
| Subject Terms: |
Cirrosi hepàtica; Insuficiència hepàtica; Trasplantament hepàtic; Hepatic cirrhosis; Liver failure; Hepatic transplantation |
| Description: |
Background and Aims Although GEMA-Na outperforms MELD 3.0 for liver allocation, concerns about the subjectivity of its ascites component persist. We compared the performance of a GEMA-Na iteration that excludes ascites with other allocation scores. Approach and Results A multinational cohort study was conducted, including adult candidates for elective liver transplantation in the UK (2010-2020), Australia (1998-2020), and Spain (2016-2021). The primary outcome was mortality or delisting for sickness within 90 days. The prognostic impact of ascites was evaluated using multivariable Cox's regression. Discrimination was assessed using Harrell's c-statistics (Hc). The study included 15 391 patients (28.5% women). The prevalence of the primary outcome was 5.8% in the UK, 5.3% in Australia, and 4.7% in Spain. The presence and severity of ascites was associated with an incremental risk of the primary outcome: 3.3% without ascites, 5.8% with mild ascites, and 7.7% with moderate-severe ascites (p < 0.001). Removal of ascites from the GEMA-Na score resulted in a one-point reduction in 18% of patients (52.4% of patients with moderate-severe ascites). GEMA-Na without ascites showed only a marginal decrease in discrimination (Hc = 0.755 vs. Hc = 0.753; p = 0.007) but still significantly outperformed MELD 3.0 (Hc = 0.734; p < 0.001) and MELD-Na (Hc = 0.737; p < 0.001). In women, GEMA-Na with and without ascites demonstrated comparable discrimination (Hc = 0.784 vs. Hc = 0.783; p = 0.61), both outperforming MELD 3.0 (Hc = 0.750; p < 0.001), and MELD-Na (Hc = 0.749; p < 0.001). Conclusions Despite the prognostic impact of ascites among liver transplant candidates, GEMA-Na without ascites outperformed other scores in predicting wait-list outcomes and may be used wherever the inclusion of ascites is considered too subjective. |
| Document Type: |
article in journal/newspaper |
| File Description: |
11 p.; application/pdf |
| Language: |
English |
| Relation: |
Reproducció del document publicat a: https://doi.org/10.1111/liv.70520; Liver International, 2026, vol. 46, issue. 3, p. e70520; https://doi.org/10.1111/liv.70520; https://hdl.handle.net/2445/230549; 1608883 |
| Availability: |
https://hdl.handle.net/2445/230549 |
| Rights: |
cc-by (c) Rodríguez Perálvarez, Manuel Luis et al., 2026 ; http://creativecommons.org/licenses/by/4.0/ ; info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.241C63F2 |
| Database: |
BASE |