Gender disparity in liver transplant waiting-list mortality: The importance of kidney function

Authors

  • Ayse L. Mindikoglu,

    Corresponding author
    1. Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
    • Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 22 South Greene Street N3W50, Baltimore, MD 21201
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    • Telephone: 410-328-1358; FAX: 410-328-1897

  • Arie Regev,

    1. Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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  • Stephen L. Seliger,

    1. Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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  • Laurence S. Magder

    1. Division of Biostatistics and Bioinformatics, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD
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Errata

This article is corrected by:

  1. Errata: Erratum: Gender disparity in liver transplant waiting-list mortality: The importance of kidney function Volume 17, Issue 9, 1119, Article first published online: 22 August 2011

  • This work was supported in part by the Health Resources and Services Administration (contract 234-2005-370011C). The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The project described was supported by Grant Number 1 K23 DK089008-01 from the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (to Ayse L. Mindikoglu M.D., M.P.H.) and its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the NIH.

Abstract

Previous studies of men and women on the liver transplantation (LT) waiting list, without taking transplantation rates into account, have suggested a higher risk of mortality for women on the waiting list. The objective of this study was to compare men and women with respect to dying within 3 years of registration on the LT waiting list and to take into account both the immediate mortality risks and the transplantation rates. The analysis was based on Organ Procurement and Transplantation Network data for patients with end-stage liver disease (ESLD) on the waiting list who were registered between February 2002 and August 2009. Competing risk survival analysis was performed to assess the gender disparity in waiting-list mortality; 42,322 patients and 610,762 person-months of waiting-list experience were included in the analysis. The risk of dying within 3 years of listing was 19% and 17% in women and men, respectively (P < 0.0001). Among patients with kidney disease and especially those not on dialysis with an estimated glomerular filtration rate (eGFR) ≥15 and <30 mL/minute/1.73 m2, women had a substantially higher risk of dying on the waiting list within 3 years of registration versus men (26% versus 20%, P = 0.001). This disparity was related to lower transplantation rates in women (transplantation rate ratio = 0.68, P < 0.0001). Controlling for eGFR and other variables related to mortality risk, we found that the overall female-male disparity disappeared. In conclusion, among patients with ESLD and kidney dysfunction who are not on dialysis, there is a substantial gender disparity in LT waiting-list mortality. Our analysis suggests as an explanation the fact that women have lower transplantation rates than men in this group. The lower transplantation rates can be explained in part by the fact that Model for End-Stage Liver Disease scores tend to be lower for women versus men because they are based on serum creatinine rather than the glomerular filtration rate. Liver Transpl 16:1147–1157, 2010. © 2010 AASLD.

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