The disparities in LT between sexes are likely multifactorial and extend beyond height and listing MELD score 11. Height contributes, but does not entirely explain the disparities in wait list mortality and access to LT between men and women 3. Women have smaller body size, which may limit the acceptability of a potential liver allograft if the available organ comes from a larger individual 9, 10. However, no study was able to show that sex-adjustment of MELD score would eliminate this inequity 8. One proposed factor was a systematic bias in MELD score, which disadvantages women given their lower muscle mass and, consequently, their serum creatinine 5, 6, 7. The disparity in liver transplantation rates between men and women have been examined in various analyses, and several contributing factors have been speculated. Population-based studies showed that women are at a disadvantage through all stages in the process of transplant evaluation, from diagnosis of liver disease to enrollment on the waiting list 4. Furthermore, in the MELD era women are more likely than men to die while waiting for a donor organ 1, 2, 3. Women are 30% less likely to undergo LT and the disparity has increased after the introduction of MELD-based allocation system 1. Sex-based disparities in liver transplantation (LT) have been recognized but not well understood.
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