*Purpose: The frequency of simultaneous liver-kidney transplantation (SLKT) has been rising since the implementation of the Model for End-stage Liver Disease (MELD)-liver allocation system in 2002. Gender disparities in access to SLKT and outcomes post-transplantation are not well described. We examined whether gender disparities existed in access to SLKT and post-SLKT survival in the MELD era.

*Methods: We included a retrospective cohort of patients wait-listed for liver transplant (LT) between 2002-2017 with renal dysfunction (RD). Multilevel time-to-competing-events regression adjusting for center effect was used to examine the likelihood of receiving SLKT. Inverse probability of treatment weighted (IPTW) survival analyses were used to analyze posttransplant mortality outcomes. Sensitivity Analysis (SA) performed using 2 alternative definitions of RD for LT candidates: SA(1), either received dialysis or having creatinine ≥2.0 mg/dL at listing for LT, and SA(2), either received dialysis or having eGFR<35 mL/min/1.73 m2 at listing for LT.

*Results: Among candidates not listed for SLKT at the time of listing for LT, females had ≥50% lower likelihood of receiving SLKT compared to males (Figure 1). Females continued to have reduced access despite being listed for SLKT. Once transplanted, we found no statistically significant difference in post-transplant survival by sex for SLKT or LT alone recipients (Figure 2).

*Conclusions: Prior to the implementation of the SLKT allocation policy, gender disparities were found in access to SLKT but not in post-transplant survival. A tighter gender difference in access to SLKT was found amongst patients listed for SLKT compared to those not listed simultaneously.

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