Table 3.

Sex differences in liver transplant by disease.

Liver disease	Epidemiology	Risk of cirrhosis/need for LT	Post-LT outcome
HCV	Less common in women [67]	Lower need for LT in women: related to higher spontaneous clearance, lower risk of fibrosis, and less concurrent alcohol use [66-68] Fibrosis progression may be more rapid in post- than pre-menopausal women [69]	Women at higher risk of graft loss [72-74] Possible lower risk of interferon response post LT [75] No apparent difference in response to new direct acting antivirals Women at higher risk of early acute rejection [28]
NASH	NAFLD more common in men Biopsy proven NASH higher in women [77-79]	Similar rates of fibrosis in men and pre-menopausal women [81-82]. Fibrosis progression may be more rapid in post-than pre-menopausal women [80] Similar transplant rates [78]	Similar rates of recurrent disease, patient, and graft survival [83-86]
ALD	Less common in women [90,92,93]	Women at higher risk of cirrhosis with lower doses of alcohol exposure [87] Men account for 75% of transplants for ALD [78]	Similar patient and graft survival [91-94] Recidivism controversial: may be higher in women [95-96]
AIH	More common in women, sex ratio 3.6:1 [97]	Controversial: male sex predictive of death or need for LT [98-99] Women with AIH at lower risk for HCC [98]	Similar post LT survival, recurrent AIH, and risk of rejection [101-103]
PBC	90% diagnosed in women [104]	Women more responsive to ursodiol [108] Women have less progressive disease [101,106,107] Women with PBC at lower risk for HCC [109-112]	Similar risk of recurrent PBC and rejection [101,113] Limited data on post LT survival differences
PSC	60% diagnosed in men [114]	Controversial: Most studies show no difference in transplant-free survival [115,116] One study found female sex predictive of death or need for liver transplant [117]	Similar risk of recurrent PSC [120-122] and rejection [101] Limited data on post LT survival differences