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Review
. 2023 Aug 1;28(4):254-258.
doi: 10.1097/MOT.0000000000001081. Epub 2023 Jun 9.

The sex disparity in liver transplantation

Rachel Hogen  1 , Matthew Hunter Witt, Kiran Dhanireddy
Affiliations
Review

The sex disparity in liver transplantation

Rachel Hogen et al. Curr Opin Organ Transplant. .

Abstract

Purpose of the review: This review describes the sex disparity in liver transplantation (LT) and explains its underlying causes.

Recent findings: There is a small but persistent sex disparity in transplant rate and waitlist mortality that disappears once women are listed as Status 1. Allocation systems that could replace the Model for End Stage Liver Disease (MELD)-Na with scores less reliant on serum creatine and muscle mass have the potential to alleviate part of the sex disparity. Women perform worse on frailty assessments and are more likely to have nonalcoholic steatohepatitis (NASH). A diagnosis of NASH is compounding risk factor for frailty.

Summary: Women remain disadvantaged in their access to LT despite multiple evolutions of the allocation system. An allocation system that relies less heavily on serum creatinine could partially alleviate the sex disparity. As NASH becomes more prevalent and frailty becomes more important in listing decisions, we may also need to carefully consider differences in the manifestations of frailty between the genders.

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References

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    1. Lai JC, Pomfret EA, Verna EC. Implicit bias and the gender inequity in liver transplantation. Am J Transplant 2022; 22:1515–1518.
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