A study led by Massachusetts General Hospital (MGH) shows women with hepatocellular carcinoma are less likely to receive a liver transplant than men with the same condition.
Women with this kind of cancer were also more likely to die or be taken off the organ transplant list due to health deterioration while waiting for a new liver according to the research, which is published in JAMA Surgery.
Hepatocellular carcinoma is the most common form of primary liver cancer in the U.S., accounting for around 65% of cases of liver cancer. Less women (around 26% of cases) than men are affected by this kind of cancer, but mortality rates have gone down more in men than in women with hepatocellular carcinoma over the last 25 years.
Liver transplant can be an effective treatment for this kind of cancer, with a risk of recurrence of less than 15% and a 50% or higher survival rate at 10 years, as opposed to an 18% five-year survival rate without this treatment.
Female patients with end-stage liver disease are known to be less likely to receive donor livers and be more likely to die on the waiting list.
“This disadvantage is due to the underestimation of their Model for End-Stage Liver Disease (MELD) score from lower baseline creatinine levels and concerns about size mismatch,” explains Allan Tsung, a professor of surgical oncology at the University of Virginia, in an invited commentary article in the same journal.
“Although the MELD score has been revised to better represent female patients’ physiological condition, it remains unclear if these adjustments are sufficient for patients with hepatocellular carcinoma who receive exception points, prioritizing them for transplant.”
The current study, led by Heidi Yeh, surgical Director of the Abdominal Pediatric Transplant Program at Mass General for Children, and the interim surgical director of the Adult Liver Transplant Program at Massachusetts General Hospital, assessed links with sex and transplant likelihood or general outcome in 31,725 adults with hepatocellular carcinoma who were on the liver transplant waiting list between 2010 and 2023.
The likelihood of receiving a liver transplant within one year of joining the list was 54% in men vs 51% in women. Women were more likely to die or be delisted during their first year on the list because their health deteriorated at 16% vs 15% for men.
When the researchers adjusted for height and weight, the association with female sex decreased in larger women, but in those below the height of 166 cm women were still less likely to undergo a transplant than men.
“These findings suggest that for liver transplant candidates wait-listed with exception scores, additional changes to allocation policy are needed to resolve the sex disparity, including solutions to improve access to livers for smaller candidates,” concluded Yeh and co-authors.
