Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2015; 7(3): 460-467
Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.460
Gender-based disparities in access to and outcomes of liver transplantation
Omobonike O Oloruntoba, Cynthia A Moylan
Omobonike O Oloruntoba, Cynthia A Moylan, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States
Cynthia A Moylan, Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC 27710, United States
Author contributions: Oloruntoba OO reviewed and analyzed data; wrote the manuscript; Moylan CA analyzed data, wrote the manuscript and made critical revisions related to intellectual content of manuscript and its revisions.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Cynthia A Moylan, MD, Assistant Professor, Division of Gastroenterology, Duke University Medical Center, 905 South LaSalle Street, GSRB1, DUMC 3256, Durham, NC 27710, United States.
Telephone: +1-919-668-0401 Fax: +1-919-6848857
Received: August 29, 2014
Peer-review started: August 30, 2014
First decision: November 19, 2014
Revised: December 3, 2014
Accepted: December 16, 2014
Article in press: December 16, 2014
Published online: March 27, 2015

Despite comprising 35% of transplants, the number of female transplant recipients has continued to decline. Accordingly, there is a growing attention to the issue of access to and outcomes of liver transplantation in women. The purpose of this review is to critically evaluate the published literature on etiologies contributing to gender-based disparities in liver transplantation focusing on the steps from chronic liver disease through transplantation including disparities in liver disease prevalence, access to liver transplant centers and transplant waiting list, receipt of liver transplantation once listed and disparities in post-liver transplantation outcomes. Our review finds factors contributing to this disparity may include gender differences in the etiology of underlying liver disease and patient and physician referral patterns, lifestyle and health care, but also utilization of an imperfect organ allocation system based on the model for end stage liver disease score and donor-recipient liver size matching. The review also highlights the need for further research in the area of gender disparity in order to develop appropriate approaches to address it and to improve allocation of this precious resource in the future.

Keywords: Female gender, Liver transplantation, Creatinine, Model for end stage liver disease, Disparity

Core tip: Liver transplantation is a life-saving procedure for many patients with end stage liver disease therefore it is of utmost importance to ensure equity in its distribution. Recently, growing attention has been placed on the issue of gender disparity in access to and receipt of a liver transplant. Factors contributing to this disparity include important differences in the etiology of underlying liver disease and indications for liver transplant that differ by gender. Systematic bias against women also appears to exist in many of the crucial steps of organ allocation. Better understanding of those mechanisms and their solutions are needed to improve liver transplantation rates in women.