Women Are Also Disadvantaged in Accessing Transplant Outside the United States: Analysis of the Spanish Liver Transplantation Registry

Transpl Int. 2024 May 7:37:12732. doi: 10.3389/ti.2024.12732. eCollection 2024.

Abstract

Sex inequities in liver transplantation (LT) have been documented in several, mostly US-based, studies. Our aim was to describe sex-related differences in access to LT in a system with short waiting times. All adult patients registered in the RETH-Spanish Liver Transplant Registry (2000-2022) for LT were included. Baseline demographics, presence of hepatocellular carcinoma, cause and severity of liver disease, time on the waiting list (WL), access to transplantation, and reasons for removal from the WL were assessed. 14,385 patients were analysed (77% men, 56.2 ± 8.7 years). Model for end-stage liver disease (MELD) score was reported for 5,475 patients (mean value: 16.6 ± 5.7). Women were less likely to receive a transplant than men (OR 0.78, 95% CI 0.63, 0.97) with a trend to a higher risk of exclusion for deterioration (HR 1.17, 95% CI 0.99, 1.38), despite similar disease severity. Women waited longer on the WL (198.6 ± 338.9 vs. 173.3 ± 285.5 days, p < 0.001). Recently, women's risk of dropout has reduced, concomitantly with shorter WL times. Even in countries with short waiting times, women are disadvantaged in LT. Policies directed at optimizing the whole LT network should be encouraged to guarantee a fair and equal access of all patients to this life saving resource.

Keywords: Spanish Liver Transplant Registry (RETH); access to transplantation; sex inequity; survival; waiting list; women.

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular / surgery
  • End Stage Liver Disease / surgery
  • Female
  • Health Services Accessibility* / statistics & numerical data
  • Healthcare Disparities / statistics & numerical data
  • Humans
  • Liver Neoplasms / surgery
  • Liver Transplantation* / statistics & numerical data
  • Male
  • Middle Aged
  • Registries*
  • Severity of Illness Index
  • Sex Factors
  • Spain
  • United States
  • Waiting Lists*

Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article. This research was funded by the Instituto de Salud Carlos III and co-funded by European Regional Development Fund “A way to make Europe” (grants number PI19/01360- MB, and INT20/00061-MB), by the Generalitat Valenciana (grant AICO/2021/035-MB), and by the CIBER -Consorcio Centro de Investigación Biomédica en Red- [CB06/04/0065], Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea—European Regional Development Fund. No sponsor had a role in the study design, the data collection, the analysis and interpretation of data, the writing of the paper or the decision to submit the article for publication.