Sex and Race Disparities in Liver Listings and Transplants in the United States

Alcohol-associated liver disease (ALD) and metabolic dysfunction-associated steatohepatitis (MASH) are becoming leading indications for liver transplant (LT) in the United States. Data on trends based on sex and race are limited.

A cohort of LT listings in adults (2011-2023) for common indications of ALD, MASH, and hepatitis C virus was stratified to hepatocellular carcinoma (HCC) and non-HCC indications. Change in proportion for each etiology in 2023 vs 2011 was derived.

Of 21,087 HCC listings, MASH dominated in males and females, but ALD dominated in black males and in black and Hispanic females. Of 12,087 HCC LT, MASH dominated in both sexes and races, except ALD dominated in black males. Of 80,433 non-HCC listings, ALD dominated in both sexes and races, except MASH dominated in black and Hispanic males. Of 46,289 non-HCC LT, ALD dominated in both sexes and all races.

Our study findings call for public policies to address the rising burden from ALD and MASH and sex/ethnic disparities.