Impact of estimated liver volume and liver weight on gender disparity in liver transplantation§

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

  • Sukru H. Emre,

    1. Yale New Haven Transplantation Center, Department of Surgery, Yale University School of Medicine, New Haven, CT
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  • Laurence S. Magder

    1. Division of Biostatistics and Bioinformatics, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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  • The Institutional Review Board (IRB) of the University of Maryland, Baltimore has determined that the analysis of Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Database is not human subject research and does not need to be reviewed.

  • This work was originally published as an abstract [Hepatology 2011;54(suppl 1):167A]. The abstract was selected as a presidential poster of distinction and was presented at the 2011 Liver Meeting of the American Association for the Study of Liver Diseases in San Francisco, CA.

  • §

    This work was supported in part by the Health Resources and Services Administration through contract 234-2005-370011C. The contents are the responsibility of the authors alone and do 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 5 K23 DK089008-02 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

Although lower Model for End-Stage Liver Disease (MELD) scores due to lower levels of serum creatinine in women might account for some of the gender disparity in liver transplantation (LT) rates, even within MELD scores, women undergo transplantation at lower rates than men. It is unclear what causes this disparity, but transplant candidate/donor liver size mismatch may be a factor. We analyzed Organ Procurement and Transplantation Network data for patients with end-stage liver disease on the waiting list. A pooled conditional logistic regression analysis was used to assess the association between gender and LT and to determine the degree to which this association was explained by lower MELD scores or liver size. In all, 28,866 patients and 424,001 person-months were included in the analysis. The median estimated liver volume (eLV) and the median estimated liver weight (eLW) were significantly lower for women versus men on the LT waiting list (P < 0.001). When we controlled for the region and the blood type, women were 25% less likely to undergo LT in a given month in comparison with men (P < 0.001). When the MELD score was included in the model, the odds ratio (OR) for gender increased to 0.84, and this suggested that 9 percentage points of the 25% gender disparity were due to the MELD score. When eLV was added to the model, there was an additional 3% increase in the OR for gender, and this suggested that transplant candidate/donor liver size mismatch was an underlying factor for the lower LT rates in women versus men (OR = 0.87, P < 0.001). In conclusion, lower LT rates among women on the waiting list can be explained in part by lower MELD scores, eLVs, and eLWs in comparison with men. However, at least half of the gender disparity still remains unexplained. Liver Transpl 19:89–95, 2013. © 2012 AASLD.

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