A RECENT study has highlighted a concerning gender disparity in access to liver transplants, showing that women on the liver transplant waiting list are less likely to undergo a transplant than men, particularly those with hepatocellular carcinoma (HCC). While recent updates to the Model for End-Stage Liver Disease (MELD) scoring system have aimed to address this gap, they have not fully resolved the issue for patients relying on exception scores, such as those with HCC.
The retrospective cohort analysis examined data from 31,725 adults who were wait-listed for liver transplants and received HCC exception scores between January 2010 and March 2023. The research team explored the association between female sex, patient size, and access to transplants, focusing on two main outcomes: the likelihood of deceased-donor liver transplant (DDLT) and the risk of death or removal from the waiting list due to health deterioration.
Results showed a clear disadvantage for women compared to men. Women had a lower 1-year cumulative incidence of DDLT (50.8% versus 54.0%) and a higher incidence of death or delisting due to health deterioration (16.2% versus 15.0%). Even after adjusting for variables such as height and weight, women were less likely to receive a transplant, particularly those with a height below 166 cm.
The study suggested that sex-based differences in size play a significant role in these disparities. After adjusting for height and weight, the difference in transplant access between men and women was reduced. However, smaller women remained at a disadvantage, as they struggled to access size-matched donor livers.
These findings have demonstrated the need for additional policy changes to improve liver transplant access for women, particularly those who are shorter. The researchers involved in the study have called for further modifications to allocation policies to ensure smaller candidates, regardless of sex, have fair access to life-saving transplants.
Victoria Antoniou, EMJ
Reference
Cron D et al. Sex and size disparities in access to liver transplant for patients with hepatocellular carcinoma. JAMA Surg. 2024;DOI:10.1001/jamasurg.2024.3498.
