Female gender in the setting of liver transplantation

Table 1 Key points

Several factors contribute to the unequal access to liver transplantation that penalizes women, including inadequacy of MELD score in accounting for renal dysfunction in females, the limitation of MELD score in reflecting the actual severity of liver disease and associated complications in certain clinical conditions that are more frequent in women, and the centers’ increasing prevalence of policies that favor transplantation for hepatocellular carcinoma, which is more frequent in males

Different etiologies of liver disease follow a characteristic pattern of gender-related frequency, natural evolution, and response to treatment, partly owing to socioepidemiological factors as well as to phenotypical differences regarding enzymatic activity and hormonal status

Within the female population, a clear difference exists between the pre- and the post-menopausal stages, and after this turning point, the protective effect of estrogens on slowing fibrosis progression, amongst others, is lost, causing an acceleration of hepatic injury, a detrimental response to therapy, and the potential establishment of a new set of complications associated with altered fat and bone metabolism

Although long-term overall outcomes after liver transplantation are better in women, certain conditions such as renal dysfunction, hepatocellular carcinoma as an indication for transplant and recurrent hepatitis C infection are associated with worse prognosis in women with respect to men

In spite fertility and sexual activity may be curbed in advanced cirrhosis, there are numerous reports of unaffected pregnancies in this stage, while successful liver transplantation restores fertility and sexual activity in most patients, with pregnancy outcomes which are reportedly better in comparison to those obtained after kidney transplantation

MELD: Model for end-stage liver disease.