*Purpose: From an epidemiology perspective, menopausal women are an increasing proportion of the population, and menopause represents an important stage in which hormonal changes and aging influence liver-related health. Given the increasing prevalence of menopausal women and the potential effects of menopause on liver-related health, this study aimed to quantify the proportion of menopausal women who have undergone liver transplant and describe their outcomes in relation to those of other populations of liver transplant recipients.

*Methods: The database of the Organ Procurement and Transplantation Network of the United Network for Organ Sharing was used to identify recipients of liver transplants that occurred between January 1, 2003 and December 31, 2015 and who were 18 years or older. Menopausal women were defined as 51 years or older. Three other groups were created: premenopausal women (under 51 years), younger men (under 51 years), and older men (51 years or older).

*Results: A total of 75,946 liver transplants were identified. Older men are the largest proportion of liver transplant recipients (48%). Menopausal women represent 22% of liver transplant recipients. Menopausal women have the longest median waitlist time of patients at 98 days, compared 95 days for older men, 43 days for younger women, and 54 days for younger men. Younger men and premenopausal women have higher median MELD scores at listing compared to older men and menopausal women (19.0 for each compared to 15.0 and 16.0, respectively). Older men have higher rates of not being hospitalized at time of transplant compared to all other age-sex groups. Within the first year, there is a comparable survival rate between the age-sex groups, such that approximately 85% of transplant recipients are alive with no retransplantation. There is approximately 12% mortality. By the third year, older men and menopausal women have close to 20% mortality, compared to about 15% mortality for younger men and premenopausal women. Younger recipients have a higher proportion of re-transplantation compared to older recipients at one year and three years post-transplant.

*Conclusions: Menopausal women represent almost a quarter of all adult liver transplant recipients and have longer wait times. Their post-transplant survival is comparable to men of similar age but lower than that of younger men and premenopausal women. Further studies are needed to assess more fully the determinants of these findings.

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