Female liver transplant candidates face lower access to transplantation. Size match between the offered liver and the candidate is important but has not been considered when evaluating this disparity in access. The goal of this study was to better understand the contributions of size match to the commonly described sex disparity in access to liver transplantation.

METHODS: Using 2010-2015 SRTR data, we identified livers offered to 66,505 adult candidates. We calculated estimated liver volume (eLV) and donor/recipient body surface area index (BSAi) to identify small-for-size (BSAi<0.78), normal-for-size (0.78<BSAi<1.24), and large-for-size (BSAi>1.24) livers. We used multilevel logistic regression to identify the association between sex and offer acceptance by quartile of donor eLV, adjusting for MELD and liver quality. We explored potential mediation by candidate height and weight.

RESULTS: The distribution of donor eLV was similar between offers made to men and women (Figure), and thus, 26.4% of offers were large-for-size for women and 14.5% were small-for-size for men (Table 1). Women had 1.4-fold higher odds of accepting offers from within the smallest quartile of eLV (Table 2). However, women had statistically significantly lower odds of accepting offers from within all other quartiles. Including height and weight in the adjusted model attenuated the association between female sex and offer acceptance, yet the associations between sex and varying odds of acceptance remained (p-values<0.002).

CONCLUSION: Women were more likely than men to receive offers of inappropriate size, and less likely to accept livers larger than median size. Just as compatible kidneys are matched to highly sensitized kidney transplant candidates, smaller livers could be prioritized to smaller candidates to improve equity in liver allocation.

CITATION INFORMATION: Bowring M, Massie A, Haugen C, Ruck J, Segev D, Gentry S. Candidate Sex and Size Disparity in Liver Offer Acceptance. Am J Transplant. 2017;17 (suppl 3).

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