Background and Aims: The root causes of gender disparities in liver transplantation (LT) have not been fully elucidated. We hypothesize that the source of the disparity can be explained by differences in match run position and organ declines due to recipient small stature.

Methods:Data were analyzed from the United Network of Organ Sharing registry of all candidates on the LT waitlist between May 10, 2007 and June 17, 2013. Outcomes included: 1) being in first position on a match run, 2) having an organ declined while in first position, 3) having an organ declined in first position because of donor-recipient size mismatch defined by body surface area discordance (BSA) and, 4) death or becoming too sick for LT.

Results: There were 64,995 candidates listed for LT during the study period. Women listed without exception points were significantly less likely than men to be in first position (OR: 0.93, 95% CI: 0.88-0.99). Women who achieved first position were more likely to have an organ declined than men (OR: 1.15, 95% CI: 1.06-1.26), a difference that was attenuated after accounting for recipient BSA (OR: 1.08, 95% CI: 0.98-1.19). Women with a single organ decline were significantly more likely than men to die or become too sick for LT (OR: 1.26, 95% CI: 1.12-1.41). The disparity in too sick or death was attenuated when accounting for exception points and recipient BSA (OR: 1.16, 95% CI: 1.12-1.21 to 1.01, 95% CI: 0.96-1.06).

Conclusions: Women listed for LT are disadvantaged by an imbalance in exception point allocation and organ declines because of small stature.

CITATION INFORMATION: Nephew L, Goldberg D, Lewis J, Abt P, Bryan M, Forde K. Exceptions Points and Size Drive Gender Disparities in Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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