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Women at a Disadvantage While Awaiting a Liver Transplant

by Aid Full
In the United States, women awaiting liver transplants are about one-third more likely than men to become so ill that they can’t be operated upon or even die before the transplant.

According to a cohort study that focused on 1,405 adults (out of which 578 were women and 827 were men) suffering from cirrhosis and awaiting liver transplant without hepatocellular carcinoma, researchers tried to find out if frailty was a cause for the difference between women and men in mortality. The researchers found out that even with the same severity of the liver disease, frailty scores were worse among women.

When the waitlist mortality was taken into consideration, frailty attenuated the gender difference by mediating almost 13% of the gap. It was also found that women had a greater risk of waitlist mortality against men, close to 34%, in unadjusted regression. These results helped in establishing frailty as a novel factor associated with the gender gap in waitlist mortality for those awaiting a liver transplant.

Other Factors Responsible for the Disparity

Although geographic location is a big reason for this disparity, some researchers suggest that a more comprehensive approach is required to reduce these gender inequities in access to liver transplants. There are policies being set in place to mitigate geographic disparities but they alone can’t solve this problem. Some other factors need to be addressed as well to help the disadvantaged women, such as the inaccuracies of MELD (Model for End-stage Liver Disease) scores in diagnosing the severity of disease in women.

Jayme E. Locke (MD, MPH, Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham School of Medicine) and her colleagues conducted a retrospective cohort study to quantify that this disparity was associated with not only geographic characteristics but with clinical characteristics as well. They studied data from 81,357 adults on the Organ Procurement and Transplant Network liver-only transplant waiting list between June 18, 2013, and March 1, 2018. Among the adults, 36.1% were women (mean age of 54.7 years), and 63.9% were men (mean age of 55.7 years). The research concluded that laboratory and MELD scores (50.1% increase), as well as candidate anthropometric and liver measures (125.8% increase), played an important role in the disparities between men and women.

How to Reduce the Gender Gap?

The gender gap in waitlist mortality for those awaiting a liver transplant in quite evident and appropriate measures should be taken to mitigate this disparity. Elizabeth C. Verna (MD, MS Center for Liver Disease and Transplantation, Columbia University Irving Medical Center) and Jennifer C. Lai (MD, Department of Medicine, Division of Gastroenterology & Hepatology, University of California San Francisco) were of the opinion that changes in policy to reduce the sex-based disparity on the possibility of receiving a transplant could and should be prioritized and implemented to rectify the unforeseen consequences of existing allocation rules. Not only the changes are required on the policy level, but a much more comprehensive approach is required that includes revising MELD (Model for End-stage Liver Disease) scores to accurately estimate the disease severity in women.

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