Waitlist Mortality in Candidates Listed for Liver Transplant in Females Varies by Liver Disease Aetiology

Background and Aims A higher waitlist mortality (WLM) due to death or removal for being too sick for liver transplantation (LT) was observed among females, leading to the acceptance of Model for End‐stage Liver Disease (MELD) 3.0 for liver allocation. However, there remains a knowledge gap on the role of liver disease aetiology on sex‐based waitlist outcomes. Methods We analysed the United Network for Organ Sharing database (2014–2022) first LT listings in adults for alcoholic‐associated liver disease (ALD), metabolic dysfunction‐associated steatohepatitis (MASH), hepatitis C virus (HCV), hepatitis B virus (HBV), chronic cholestatic liver disease (CCLD) and metabolic liver disease (MLD). The cumulative 90‐day WLM for each aetiology was compared in females and males using a competing risk model, with receiving LT as the competing event. The Fine–Gray multivariable regression model was utilised to examine variables associated with waitlist outcomes. Results Among 88 747 listed candidates, females were younger (mean age 55.6 vs. 56.1 years), had a higher mean MELD score (20.9 vs. 19.5), and a higher proportion of Karnofsky performance status score (KPSS) > 40% (57.7% vs. 50%); p < 0.001 for all. Cumulative 90‐day WLM in females and males for ALD was 14.8% and 16%, respectively, with a SHR (95% CI) of 0.92 (0.86–0.99). WLM was higher in females for MASH (20.7% vs. 19.4%, 1.08 [1.00–1.16]) and for CCLD (15.1% vs. 12.4%, 1.24 [1.08–1.42]). Advanced age, diabetes, lower KPSS, and high MELD scores were associated with a higher WLM, while Hispanic race was associated with a lower WLM. Conclusion 90‐Day waitlist mortality in females is lower for ALD and higher for MASH and CCLD.