Gender disparities in liver transplantation

Gender disparities significantly influence outcomes in liver transplantation (LT), impacting disease prevalence, progression, access to transplantation and post-transplant outcomes. This review synthesizes current knowledge on prevalence, biological, physiological, psychosocial and systemic factors contributing to these disparities. Epidemiological studies consistently demonstrate gender-based differences in liver disease etiology and progression, influenced by hormonal, genetic and lifestyle factors. Women experience specific challenges such as higher risks associated with alcohol metabolism and increased susceptibility to autoimmune and metabolic liver diseases. Despite higher disease severity and increasing prevalence, women face substantial barriers in accessing LT, primarily due to inherent biases within allocation systems such as the model for end-stage liver disease (MELD) scoring method and donor-recipient size matching protocols. Psycho-social factors, including healthcare provider biases, caregiving responsibilities and socio-economic constraints, further compound these inequities. Ethical considerations highlight the necessity for transparent, equitable practices in LT. This article underscores the importance of evidence-based policy reforms such as revised MELD scoring, standardized patient evaluations and advocacy initiatives. Addressing gender disparities through multidisciplinary research, targeted policy interventions and community engagement is critical to achieving equitable and improved outcomes for liver transplant patients across genders.