Known disparities related to race and sex in deceased donor liver transplantation also appear to influence live donor liver transplantation.

“There are significant sex disparities that disadvantage women from receiving a liver transplant,” Danielle Tholey, MD, explains. Prior studies have shown that women are 14% to 25% less likely to receive a transplant than men and are 9% to 20% more likely to die while awaiting an organ. Living donor liver transplantation (LDLT) has many benefits, including affording the recipient a better chance of receiving a transplant and not becoming too sick while awaiting a transplant.”

While the disparities related to race and sex in deceased donor liver transplantation (DDLT) are well established, less is known about these differences in LDLT. For a study published in Liver Transplantation, investigators aimed to determine “whether sex and racial disparities improved with living donor liver transplants or whether certain factors, such as insurance payor and education level, still hampered equity with live donation,” Dr. Tholey says.

The researchers examined the Organ Procurement and Transplant Network database from 2002-2021 to characterize adults receiving a LDLT and assess differences between LDLT and DDLT recipients regarding sex and race. Information about donor demographics, Model for End-Stage Liver Disease (MELD) scores, and socioeconomic status was also included.

Differences Based on Sex, But Not Race, Attenuated in LDLT

The analysis included 4,961 LDLT recipients and 99,984 DDLT recipients. Men received a greater proportion of both LDLT (55%) and DDLT (67%) compared with women (P<0.001).

Among LDLT recipients, the average age was 52.6, with no significant difference between men and women. The difference in the average age of female versus male DDLT recipients was statistically but not clinically significant (54 vs 55; P=0.01). The researchers also reported a significant difference in race between male and female recipients of a LDLT (P<0.001); 84% of men were White compared with 78% of women.

There were more living donors who were women, and 50% of women donors donated to men, but only 40% of men donated to women. In both groups, women had less education and were less likely to have private insurance.

“While still present, sex differences were attenuated in live donation compared with deceased donation,” Dr. Tholey says. “Despite the existence of mostly women donors, more men received live donor transplants than women.”

Racial disparities were not attenuated with LDLT. “LDLT recipients were more often White than deceased donor recipients (Table),” she continues. “Interestingly, when evaluating sex differences within each racial category, deceased donor recipients were more likely to be male in every category, whereas more Hispanic and Black women received LDLT compared with men.”

The study also identified key differences in BMI, donor relationships, and socioeconomic factors, all of which may contribute to disparities in sex and race, Dr. Tholey says.

Achieving “Access for All” in Living Donor Liver Transplants

The results indicate that disparities related to sex and race exist for both living and deceased liver transplantation, though the sex disparities are less pronounced in the LDLT population, according to the study results.

Dr. Tholey notes that careful selection of living donors can decrease some of these disparities.

“Further measures are needed to address potential barriers related to sex and race, including targeted patient education and a focus on achieving financial neutrality and access for all,” she says. “Programs such as the National Minority Organ Tissue Transplant Education Program and Donor Shield are a start to addressing these issues, but more efforts are needed.