*Purpose: Disparities in receipt of liver transplantation (LT) by gender and race have been documented, limiting access to this life saving treatment for particular patient subgroups. Across many fields of medicine, intersectional disparities, or disparities within disparities, often occur such that gender disparities are exacerbated within racial minorities in comparison to Whites.

*Methods: Using OPTN data for patients waitlisted for LT between 2002 and 2017, we examined whether gender disparities in receipt of LT, waitlist removal without LT, and death on the waitlist was more severe among Blacks in comparison to Whites. Competing risks analyses were conducted using proporational cause-specific hazards models and stratified by race.

*Results: The analysis sample included 93,057 White and 11,593 Black adult patients. In both races, men were significantly more likely to receive LT than women, but this difference was larger among White patients: White hazard ratio (HR) = 1.17 (95% CI: 1.15, 1.19); Black HR = 1.07 (95% CI: 1.02, 1.12). Similarly, the gender disparity around death on the waitlist was worse among White patients (HR = 0.93, 95% CI: 0.89, 0.96) than Black patients (HR = 0.99, 95% CI: 0.90, 1.10), who had no observed disparity in death. However, the gender disparity in waitlist removal without LT or death (e.g., too sick for LT, refused) was largely similar between racial groups: White HR = 0.85 (95% CI: 0.82, 0.88); Black HR = 0.88 (95% CI: 0.80, 0.97).

*Conclusions: In comparison to men, women are less likely to receive LT and more likely to be removed from or die on the waitlist. This disparity is slightly larger among White patients in comparison to Blacks. Since Black patients have a similar absolute transplant rate and rate of death on the waitlist, the larger gender disparity among Whites does not reflect a general disadvantage among Black patients of both genders in comparison to Whites. More research is needed to determine the cause of more severe gender disparities among White patients pursuing LT.

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