Access to liver transplant for women in Spain: a national registry analysis.

Abstract

Background and aims: Gender inequities in liver transplantation (LT) have been documented recently in several studies. Providing national data is crucial as poorer access to liver transplantation for women than men might be explained by different analytical approaches or different national contexts. Our aim was to describe the recipient profile over time in Spain, particularly regarding potential sex-related differences in access to LT. Method: All adult patients registered in the RETH-Spanish Liver Transplant Registry from 2000 to 2018 for LT were included. Baseline demographics, presence of hepatocellular carcinoma (HCC), cause and severity of liver disease, time on the waiting list (WL), access to transplantation, and reasons for removal fromthe WL were assessed. Results: 9427 patients were analyzed (77.6% men, 55.3 ± 8.6 years of age). Mean MELD score was reported for 3404 patients (36.1%), and was 16.5 ± 5.8. Women were less likely to receive a transplant than men (OR 0.84, 95% CI 0.73, 0.97) and more likely to be excluded for deterioration (HR 1.21, 95% CI 1.02, 1.44), despite similar liver disease severity (MELD score 16.6 ± 5.8 vs 16.5 ± 5.8 respectively, N.S) and only a slightly longer mean time on the WL (244 ± 398 days for women vs 213 ± 324 for men, p = 0.001). In recent years, this difference in access to LT was less significant (before 2011 women’s HR for exclusionwas 1.51 [95% CI 1.01, 2.26] vs 1.17 [95% CI 0.97, 1.41] after 2011) and could be attributed to overall shorter mean WL times after 2011 (398 ± 602 vs 154 ± 217 days respectively, p < 0.001). When analyzed by MELD, WL times were similar by sex for patients with scores under 16 or above 20, but women had significantly longer mean WL times than men with MELD scores 16–20 (270 ± 267 vs 211 ± 207 days respectively, p < 0.001). Women were shorter (170.5 ± 9.7 vs 158.5 ± 9.8 cm) but had a similar BMI compared to men. Inwomen, the main indications for transplant were cholestatic liver diseases, autoimmune hepatitis and NASH, whilst in men it was alcohol (p < 0.001). Women had less HCC than men (27.1 vs 16.6%, p < 0.001). Conclusion: Shorter WL times contribute to a more equal access to LT by sex, as it prevents women from deteriorating while waiting and therefore being excluded from the list.