Women with hepatocellular carcinoma (HCC) are less likely to receive a deceased-donor liver transplant (DDLT) and more likely to die while wait-listed than men, according to a study published online Sept. 4 in JAMA Surgery.

David C. Cron, M.D., from Massachusetts General Hospital in Boston, and colleagues examined whether there are sex- or size-based disparities in access to DDLT. The analysis included 31,725 U.S. adult wait-listed liver transplant candidates receiving exception scores for HCC (Jan. 1, 2010, to March 2, 2023).

The researchers found that compared with men, women had a lower one-year cumulative incidence of DDLT (50.8 versus 54.0 percent) and a higher one-year cumulative incidence of death or delisting for health deterioration (16.2 versus 15.0 percent). Compared with men, women had a lower incidence of DDLT after adjustment, but without accounting for size (subdistribution hazard ratio [SHR], 0.92; 95 percent confidence interval [CI], 0.89 to 0.95), as well as a higher incidence of death or delisting (SHR, 1.06; 95 percent CI, 1.00 to 1.13). When adjusting for height and weight, there was no association seen between female sex and incidence of DDLT or death or delisting, overall, but short women (

“These findings suggest that for liver transplant candidates wait-listed with exception scores, additional changes to allocation policy are needed to resolve the sex disparity, including solutions to improve access to livers for smaller candidates,” the authors write.

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