Abstract
To determine if there exists a sex-related difference in the rate of liver transplantation (LT) and locoregional therapy for patients with hepatocellular carcinoma (HCC) exception points in the United States. Retrospective evaluation of the UNOS STAR database was performed evaluating all adult patients with HCC meeting T2 criteria listed for LT between 2005 and 2015. Patient demographics, probability of LT, wait time to LT, and locoregional therapy rates were evaluated. A total of 14,844 patients (76.8% male) were included. Median age for men was 58 years (IQR: 54-62 years) compared to 60 years of age for women (IQR: 55-65 years), p < 0.001. Median height for men was 175 cm (range, 170-180 cm) compared to 160 cm for women (range, 157- 165 cm), p < 0.001. Within 3-years of listing for LT, the probability of LT was 79.8% for men compared to 78.2% for women (p < 0.001). Median time to LT for men was 3.6 months (range, 1.3-7.5 months) compared to 4.1 months for women (range, 1.6-8.4 months), p<0.001. There was no significant difference in locoregional therapy rates between men and women, p = 0.63. Women have a longer wait time to and a lower probability of LT, despite similar rates of locoregional therapies. The likelihood of female sex and smaller stature may result in a lower probability of LT. Additional MELD exception points for women may help bridge this sex-related disparity.
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