Sex and Size Disparities in Access to Liver Transplant for Patients With Hepatocellular Carcinoma

作者：David C. Cron, Rafal D. Mazur, Irun Bhan, Joel T. Adler, Heidi Yeh · 发表于：JAMA Surgery · 年份：2024 · DOI：10.1001/jamasurg.2024.3498 · 被引用次数：12 · 研究领域：Organ Transplantation Techniques and Outcomes、Hepatocellular Carcinoma Treatment and Prognosis、Liver Disease and Transplantation

Importance: Women on the liver transplant waiting list are less likely to undergo a transplant than men. Recent approaches to resolving this disparity have involved adjustments to Model for End-Stage Liver Disease (MELD) scoring, but this will not affect candidates who rely on exception scores rather than calculated MELD score, the majority of whom have hepatocellular carcinoma (HCC). Objective: To evaluate the association between female sex, candidate size, and access to liver transplant among wait-listed patients with HCC. Design, Setting, and Participants: This retrospective cohort study used US transplant registry data of all adult (aged ≥18 years) wait-listed liver transplant candidates receiving an HCC exception score between January 1, 2010, and March 2, 2023. Exposure: Wait-listed liver transplant candidate sex. Main Outcomes and Measures: The association of female sex with (1) deceased-donor liver transplant (DDLT) and (2) death or waiting list removal for health deterioration were estimated using multivariable competing-risks regression. Results with and without adjustment for candidate height and weight (mediators of the sex disparity) were compared. Results: The cohort included 31 725 candidates with HCC (mean [SD] age at receipt of exception, 61.2 [7.1] years; 76.3% men). Compared with men, women had a lower 1-year cumulative incidence of DDLT (50.8% vs 54.0%; P < .001) and a higher 1-year cumulative incidence of death or delisting for health deterioration (16.2%...