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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Transplant. Sep 18, 2026; 16(3): 124190
Published online Sep 18, 2026. doi: 10.5500/wjt.124190
Addressing gender-based disparities in liver transplantation: A global analysis of surgical access and donor organ allocation
Sofia Rozani, Alexander Papadopoulos, Giorgos Smyrnis, Francesca Albanesi, Stavros P Papadakos, Efstathia Liatsou, Venkatesh Balaraman Sundararajan, Lorenzo Petagna, Georgia Rozani, Vasileios Vougas
Sofia Rozani, Alexander Papadopoulos, Giorgos Smyrnis, 2nd Department of Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens, Athens 11528, Attikí, Greece
Francesca Albanesi, Chirurgia Oncologica Epatogastropancreatica e Trapianto Fegato - Fondazione IRCCS Istituto Nazionale dei Tumori, Laboratory of Immunology and Applied Biology, University of Milan, Milan 20133, Italy
Stavros P Papadakos, First Department of Gastroenterology, National and Kapodistrian University of Athens, Athens 11527, Attikí, Greece
Efstathia Liatsou, Department of Surgery, Sahlgrenska University Hospital, Gothenburg 41345, Sweden
Venkatesh Balaraman Sundararajan, Department of Abdominal Organ and Multivisceral Transplant, MGM Healthcare, Chennai 600029, Tamil Nādu, India
Lorenzo Petagna, Division of Hepatic Surgery and Liver Transplantation, Azienda Ospedaliera Universitaria Pisana, Pisa 56124, Tuscany, Italy
Georgia Rozani, National and Technical University of Athens, Athens 10682, Attikí, Greece
Vasileios Vougas, First Department of Surgery and Transplant Unit, “Evangelismos” Hospital, Athens 10676, Greece
Author contributions: Rozani S, Papadopoulos A, Smyrnis G, Albanesi F, Papadakos SP, Liatsou E, Balaraman Sundararajan V, Petagna L, Rozani G, and Vougas V contributed equally to each part of this manuscript; Rozani G contributed to Figures 1 and 2; All authors thoroughly reviewed and endorsed the final manuscript.
AI contribution statement: The authors used Grammarly for language polishing; All text was subsequently confirmed for content validity by the authors.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Sofia Rozani, MD, PhD, Academic Fellow, Research Fellow, 2nd Department of Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens, Vas. Sofias Street 76, Athens 11528, Attikí, Greece. sofrozan@gmail.com
Received: June 9, 2026
Revised: July 15, 2026
Accepted: July 27, 2026
Published online: September 18, 2026
Processing time: 82 Days and 2.8 Hours
Core Tip

Core Tip: Sex- and gender-based disparities remain a significant challenge in liver transplantation despite advances in allocation systems. Female patients continue to experience lower transplant access, longer waiting times, and higher waitlist mortality due to multifactorial factors, including model for end-stage liver disease-related creatinine bias, donor-recipient size mismatch, reduced access to exception points, and barriers in referral and evaluation pathways. Recent innovations, such as model for end-stage liver disease 3.0, sex-adjusted allocation models, living donor liver transplantation, and size-aware allocation strategies, have improved equity but have not fully eliminated disparities. This review summarizes contemporary global evidence and highlights emerging approaches aimed at achieving fairer organ allocation and improved outcomes for female liver transplant candidates.

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