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

Autor:	Cron DC; Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston.; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts., Mazur RD; Harvard Medical School, Boston, Massachusetts., Bhan I; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston., Adler JT; Department of Surgery and Perioperative Care, University of Texas at Austin., Yeh H; Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston.
Jazyk:	angličtina
Zdroj:	JAMA surgery [JAMA Surg] 2024 Nov 01; Vol. 159 (11), pp. 1291-1298.
DOI:	10.1001/jamasurg.2024.3498
Abstrakt:	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% vs 15.0%; P = .002). After adjustment, without accounting for size, women had a lower incidence of DDLT (subdistribution hazard ratio [SHR], 0.92; 95% CI, 0.89-0.95) and higher incidence of death or delisting (SHR, 1.06; 95% CI, 1.00-1.13) compared with men. When adjusting for candidate height and weight, there was no association of female sex with incidence of DDLT or death or delisting. However, at a height cutoff of 166 cm, short women compared with short men were still less likely to undergo a transplant (SHR, 0.93; 95% CI, 0.88-0.99). Conclusions and Relevance: In this study, women with HCC were less likely to receive a DDLT and more likely to die while wait-listed than men with HCC; these differences were largely (but not entirely) explained by sex-based differences in candidate size. For candidates listed with exception scores, additional changes to allocation policy are needed to resolve the sex disparity, including solutions to improve access to size-matched donor livers for smaller candidates.
Databáze:	MEDLINE
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