Gender disparities in liver transplant candidates with nonalcoholic steatohepatitis

Loy, Veronica; Joyce, Cara; Bello, Sofia; VonRoenn, Natasha; Cotler, Scott J.

doi:10.1111/ctr.13297

Cited by 18 publications

(32 citation statements)

References 24 publications

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“…123 Thus, NASH women remain longer on the waiting list for transplant, are more likely to be removed, have a higher risk of death and are less likely to receive LT compared to men with NASH, even when adjusting for potential confounding covariates. As a matter of facts, when the authors compared NASH patients to HCV patients, the magnitude of sex discrepancy resulted higher in NASH patients, 124 meaning that other unknown or unintentional biases exist in organ allocation.…”

Section: Pre-transplant Workup -Assessment Of Operative Riskmentioning

confidence: 99%

Clinical impact of sexual dimorphism in non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatitis (NASH)

Burra

Bizzaro

Gonta

et al. 2021

Liver International

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NAFLD/NASH is a sex‐dimorphic disease, with a general higher prevalence in men. Women are at reduced risk of NAFLD compared to men in fertile age, whereas after menopause women have a comparable prevalence of NAFLD as men. Indeed, sexual category, sex hormones and gender habits interact with numerous NAFLD factors including cytokines, stress and environmental factors and alter the risk profiles and phenotypes of NAFLD. In the present review, we summarized the last findings about the influence of sex on epidemiology, pathogenesis, progression in cirrhosis, indication for liver transplantation and alternative therapies, including lifestyle modification and pharmacological strategies. We are confident that an appropriate consideration of sex, age, hormonal status and sociocultural gender differences will lead to a better understanding of sex differences in NAFLD risk, therapeutic targets and treatment responses and will aid in achieving sex‐specific personalized therapies.

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Section: Pre-transplant Workup -Assessment Of Operative Riskmentioning

confidence: 99%

Clinical impact of sexual dimorphism in non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatitis (NASH)

Burra

Bizzaro

Gonta

et al. 2021

Liver International

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“…However, this study was based on ICD-9 diagnosis code, whose ability to capture NAFLD-related diagnosis and complications is severely limited. Meanwhile, in a population of 76,149 patients listed for liver transplant between 2005 and 2012 of whom 7.2% were listed for NASH, Loy et al found that women with NASH cirrhosis had a higher risk of death on the liver transplant waiting list [42].…”

Section: Nafld-related Complications Gender/sexmentioning

confidence: 99%

“…NASH is the main cause of liver transplant among females and the second one in males, right after alcoholic liver disease [6,42], yet the US women with NASH are 19% less likely to receive a liver transplant compared to men [42].…”

Section: Nafld-related Complications Gender/sexmentioning

confidence: 99%

What Do We Know about Inequalities in NAFLD Distribution and Outcomes? A Scoping Review

Talens

Tumas

Lazarus

et al. 2021

JCM

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With prevalence high and rising given the close relationship with obesity and diabetes mellitus, non-alcoholic fatty liver disease (NAFLD) is progressively becoming the most common chronic liver condition worldwide. However, little is known about the health inequalities in NAFLD distribution and outcomes. This review aims to analyze health inequalities in NAFLD distribution globally and to assess the health disparities in NAFLD-related outcomes. We conducted a scoping review of global health inequalities in NAFLD distribution and outcomes according to gender/sex, ethnicity/race, and socioeconomic position from PubMed’s inception to May 2021. Ultimately, 20 articles were included in the review, most (75%) of them carried out in the United States. Males were found to have a higher NAFLD prevalence (three articles), while available evidence suggests that women have an overall higher burden of advanced liver disease and complications (four articles), whereas they are less likely to be liver-transplanted once cirrhosis develops (one article). In the US, the Hispanic population had the highest NAFLD prevalence and poorer outcomes (seven articles), whereas Whites had fewer complications than other ethnicities (two articles). Patients with low socioeconomic status had higher NAFLD prevalence (four articles) and a higher likelihood of progression and complications (five articles). In conclusion, globally there is a lack of studies analyzing NAFLD prevalence and outcomes according to various axes of inequality through joint intersectional appraisals, and most studies included in our review were based on the US population. Available evidence suggests that NAFLD distribution and outcomes show large inequalities by social group. Further research on this issue is warranted.

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“…As a result, women were 50% more likely to be listed for NASH cirrhosis however men were more likely to be transplanted for NASH (64.3% vs 52.4%, P < 0.001). Women were more likely to experience alternate outcomes including remaining on the waitlist without LT (13.3% vs 10.6%, P = 0.006), death on the waitlist (17.1% vs. 11.4%, P < 0.001) and removal from the waitlist due to clinical deterioration (12.7% vs 10.6%, P = 0.04)[ 24 ]. Given the expected rise in NASH as the leading cause of OLT, this gender/sex-based disparity will only worsen.…”

Section: Introductionmentioning

confidence: 99%

Gender disparities in transplantation

Sheikh

Locke

2021

Current Opinion in Organ Transplantation

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Purpose of review Transplantation is the life-saving therapy for patients suffering from end-organ failure, and as such, equitable access to transplantation (ATT) is of paramount importance. Unfortunately, gender/sex-based disparities exist, and despite the transplant community's awareness of this injustice, gender/sex-based disparities have persisted for more than two decades. Importantly, no legislation or allocation policy has addressed inequity in ATT that women disproportionately face. In fact, introduction of the model for end-stage liver disease-based liver allocation system in 2002 widened the gender disparity gap and it continues to be in effect today. Moreover, women suffering from kidney disease are consistently less likely to be referred for transplant evaluation and subsequently less likely to achieve a kidney transplant, yet they comprise the majority of living kidney donors. Recent findings Acknowledging gender/sex-based disparities in ATT is the first step toward interventions aimed at mitigating this long-standing injustice in healthcare. Summary This article provides a background of end-stage liver and kidney disease in women, summarizes the existing literature describing the issue of gender disparity in ATT, and identifies potential areas of intervention and future investigation.

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Gender disparities in liver transplant candidates with nonalcoholic steatohepatitis

Abstract: Women with NASH cirrhosis had a higher risk of death on the LT waiting list and were less likely to receive LT compared to men.

Cited by 18 publications

References 24 publications

Clinical impact of sexual dimorphism in non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatitis (NASH)

Clinical impact of sexual dimorphism in non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatitis (NASH)

What Do We Know about Inequalities in NAFLD Distribution and Outcomes? A Scoping Review

Gender disparities in transplantation

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