Height Contributes to the Gender Difference in Wait‐List Mortality Under the MELD‐Based Liver Allocation System

This study examined factors associated with the gender disparity in wait‐list mortality in the MELD era. Adult patients listed for liver transplantation from 2002 to 2008 were included. Females [12 585(36%)] and males [22 126(64%)] differed clinically by age (54 vs. 52 years), height (1.6 vs. 1.8 m), listing estimated glomerular filtration rate [(eGFR); 70 vs. 83 mL/min] and cirrhosis etiology. Holding MELD constant, females were at 19% (95% CI, 1.13–1.25, p < 0.001) higher risk of wait‐list mortality than males under the current allocation system. The relative hazard increased with worsening renal function, whether measured by serum creatinine or eGFR. Adjustment for MELD, age, African‐American race, cirrhosis etiology, region and ABO group attenuated this relative hazard (HR 1.16; 95% CI, 1.10–1.22; p < 0.001) but additional adjustment for height completely explained this gender disparity in wait‐list mortality (HR 1.05; 95% CI, 0.98–1.12; p = 0.2). Transplantation rates, however, remained lower among females, even after adjustment for height (HR 0.88; 95% CI, 0.82–0.92; p < 0.001). In conclusion, under the current liver allocation system, women have a 19% increased risk of wait‐list mortality compared to men with the same MELD scores. Height contributes to this gender disparity, possibly reflecting differences in transplantation rates for shorter individuals. This analysis of the current liver allocation system demonstrates that women have a 19% increased risk of wait‐list mortality compared to men with the same MELD scores, and that height contributes to this gender disparity.