Access to liver transplantation in women: progress and challenges.

Abstract

Access to liver transplantation among women remains limited due to biological and sociocultural factors. Differences in height, muscle mass, and renal function estimation significantly affect prioritization, particularly under the classic Model for End-Stage Liver Disease (MELD). Although the implementation of MELD 3.0 has reduced some disparities, structural biases persist, especially regarding exception points and graft size compatibility. Newer models such as MELD-GRAIL-Na and GEMA-Na, along with surgical strategies like split-liver and pediatric donation, offer promising alternatives. The objective of the present review is to summarize recent evidence and propose targeted measures to achieve greater gender equity in liver transplantation allocation.