Exception Points and Body Size Contribute to Gender Disparity in Liver Transplantation

Lauren D. Nephew, David S. Goldberg, James D. Lewis, Peter Abt, Mathew Bryan, Kimberly A. Forde

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Background & Aims Women are significantly less likely than men to receive a liver transplant and more likely to die on the waitlist. We investigated potential reasons for these disparities, including match run positioning and organ declines caused by small stature of female recipients. Methods We analyzed data from the United Network of Organ Sharing registry of candidates placed on the waitlist from May 10, 2007, through June 17, 2013. Primary outcomes included ranked in first position on a match run, having an organ declined while in first position, declining an organ while in first position because of size mismatch between donor and recipient (body surface area discordance), and death or becoming too sick for liver transplantation. Results Among 64,995 patients on the waitlist for liver transplantation, 23.1% of men and 15.6% of women received exception points (P <.001). Women listed without exception points were less likely than men to be ranked first (odds ratio [OR], 0.93; 95% CI, 0.88–0.99). Women who achieved first position were more likely to decline an organ than men (OR, 1.15; 95% CI, 1.06–1.26); this difference was reduced after we accounted for recipient body surface area (OR, 1.08; 95% CI, 0.98–1.19). Women with a single organ decline were more likely than men with a single organ decline to die or become too sick for transplantation (OR, 1.26; 95% CI, 1.12–1.41). The difference was reduced after we accounted for exception points (OR, 1.16; 95% CI, 1.12–1.21) and recipient body surface area (OR, 1.01; 95% CI, 0.96–1.06). Conclusions In an analysis of data from the United Network of Organ Sharing registry, we found that women when compared with men on the waitlist for liver transplantation are disadvantaged by an imbalance in exception point allocation and organ declines because of small stature.

Original languageEnglish (US)
Pages (from-to)1286-1293.e2
JournalClinical Gastroenterology and Hepatology
Volume15
Issue number8
DOIs
StatePublished - Aug 2017
Externally publishedYes

Keywords

  • Gender Disparity
  • Organ Procurement and Transplantation Network
  • Organ Size
  • UNOS

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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