Waitlist Mortality in Candidates Listed for Liver Transplant in Females Varies by Liver Disease Aetiology.

BACKGROUND AND AIMS: A higher waitlist mortality (WLM) due to death or removal for being too sick for liver transplantation (LT) was observed among females, leading to the acceptance of Model for End-stage Liver Disease (MELD) 3.0 for liver allocation. However, there remains a knowledge gap on the role of liver disease aetiology on sex-based waitlist outcomes.

METHODS

We analysed the United Network for Organ Sharing database (2014-2022) first LT listings in adults for alcoholic-associated liver disease (ALD), metabolic dysfunction-associated steatohepatitis (MASH), hepatitis C virus (HCV), hepatitis B virus (HBV), chronic cholestatic liver disease (CCLD) and metabolic liver disease (MLD). The cumulative 90-day WLM for each aetiology was compared in females and males using a competing risk model, with receiving LT as the competing event. The Fine-Gray multivariable regression model was utilised to examine variables associated with waitlist outcomes.

RESULTS

Among 88 747 listed candidates, females were younger (mean age 55.6 vs. 56.1 years), had a higher mean MELD score (20.9 vs. 19.5), and a higher proportion of Karnofsky performance status score (KPSS) > 40% (57.7% vs. 50%); p < 0.001 for all. Cumulative 90-day WLM in females and males for ALD was 14.8% and 16%, respectively, with a SHR (95% CI) of 0.92 (0.86-0.99). WLM was higher in females for MASH (20.7% vs. 19.4%, 1.08 [1.00-1.16]) and for CCLD (15.1% vs. 12.4%, 1.24 [1.08-1.42]). Advanced age, diabetes, lower KPSS, and high MELD scores were associated with a higher WLM, while Hispanic race was associated with a lower WLM.

CONCLUSION

90-Day waitlist mortality in females is lower for ALD and higher for MASH and CCLD.