title: Exception Points and Body Size Contribute to Gender Disparity in Liver Transplantation.
abstract: OBJECTIVE
  Women are significantly less likely than men to receive a liver transplant and more likely to die on the waitlist. We investigated potential reasons for these disparities, including match run positioning and organ declines caused by small stature of female recipients.
  
  
  METHODS
  We analyzed data from the United Network of Organ Sharing registry of candidates placed on the waitlist from May 10, 2007, through June 17, 2013. Primary outcomes included ranked in first position on a match run, having an organ declined while in first position, declining an organ while in first position because of size mismatch between donor and recipient (body surface area discordance), and death or becoming too sick for liver transplantation.
  
  
  RESULTS
  Among 64,995 patients on the waitlist for liver transplantation, 23.1% of men and 15.6% of women received exception points (P < .001). Women listed without exception points were less likely than men to be ranked first (odds ratio [OR], 0.93; 95% CI, 0.88-0.99). Women who achieved first position were more likely to decline an organ than men (OR, 1.15; 95% CI, 1.06-1.26); this difference was reduced after we accounted for recipient body surface area (OR, 1.08; 95% CI, 0.98-1.19). Women with a single organ decline were more likely than men with a single organ decline to die or become too sick for transplantation (OR, 1.26; 95% CI, 1.12-1.41). The difference was reduced after we accounted for exception points (OR, 1.16; 95% CI, 1.12-1.21) and recipient body surface area (OR, 1.01; 95% CI, 0.96-1.06).
  
  
  CONCLUSIONS
  In an analysis of data from the United Network of Organ Sharing registry, we found that women when compared with men on the waitlist for liver transplantation are disadvantaged by an imbalance in exception point allocation and organ declines because of small stature.
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: lauren.nephew@uphs.upenn.edu.
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Nephew
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David S
authors.initials: DS
authors.lastname: Goldberg
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: James D
authors.initials: JD
authors.lastname: Lewis
authors.affiliation: Division of Liver Transplantation, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Peter
authors.initials: P
authors.lastname: Abt
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mathew
authors.initials: M
authors.lastname: Bryan
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Forde
mesh_terms: D049628:Body Size; D005260:Female; D005783:Gender Identity; D054625:Healthcare Disparities; D018594:Human Body; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D017678:Sex Distribution
keywords: Gender Disparity; Organ Procurement and Transplantation Network; Organ Size; UNOS