{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T01:33:15Z","timestamp":1793928795725,"version":"4.8.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2022,7,30]],"date-time":"2022-07-30T00:00:00Z","timestamp":1659139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,7,30]],"date-time":"2022-07-30T00:00:00Z","timestamp":1659139200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:p>Although sex and racial disparities for liver transplantation (LT) are known, it is unclear if disparities exist for patients with alcohol\u2010associated liver disease (ALD). We aimed to compare sex and racial\/ethnic differences in mortality, LT listing, and LT rates in patients with and without ALD. We analyzed patients who were listed for LT and\/or died of end\u2010stage liver disease (ESLD) between 2014 and 2018 using the United Network for Organ Sharing Standard Transplant Analysis and Research and Centers for Disease Control and Prevention Wide\u2010ranging OnLine Data for Epidemiologic Research databases, respectively. Patients with ALD were compared with non\u2010ALD patients. Our primary outcome was the ratio of listings for LT to deaths from ESLD\u2014listing\u2010to\u2010death ratio (LDR)\u2014a previously derived metric to assess access to the waiting list. Differences between sex and race\/ethnicity were analyzed with chi\u2010square tests and multivariable linear regression. There were 65,588 deaths and 16,133 listings for ALD compared with 75,020 deaths and 40,194 listings for non\u2010ALD. LDR was lower for ALD (0.25 vs. 0.54; <jats:italic toggle=\"yes\">p<\/jats:italic> &lt;\u20090.001). Black patients had the lowest LDR in both ALD and non\u2010ALD (0.13 and 0.39 for Black patients vs. 0.26 and 0.54 for White patients; <jats:italic toggle=\"yes\">p<\/jats:italic> &lt;\u20090.001). Women with ALD had a lower LDR (0.21 vs. 0.26; <jats:italic toggle=\"yes\">p<\/jats:italic> &lt;\u20090.001), whereas women without ALD had higher LDR than men (0.69 vs. 0.47; <jats:italic toggle=\"yes\">p<\/jats:italic> &lt;\u20090.001). There were significant negative interactions between women and ALD in LDR and the transplant\u2010to\u2010death ratio. Multivariable analysis and a sensitivity analysis, with more liberal definitions of ALD and non\u2010ALD, confirmed these findings. Patients with ALD have lower access to LT. Among those with ALD, female and Black patients have the lowest access. New initiatives are needed to eliminate these inequities.<\/jats:p>","DOI":"10.1002\/lt.26544","type":"journal-article","created":{"date-parts":[[2022,7,18]],"date-time":"2022-07-18T04:17:58Z","timestamp":1658117878000},"page":"259-267","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":38,"title":["Black patients and women have reduced access to liver transplantation for alcohol\u2010associated liver disease"],"prefix":"10.1097","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0286-9258","authenticated-orcid":false,"given":"Alyson","family":"Kaplan","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6372-6904","authenticated-orcid":false,"given":"Nabeel","family":"Wahid","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett E.","family":"Fortune","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA"},{"name":"Center for Liver Disease and Transplantation, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Verna","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Disease, Columbia University Irving Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Halazun","sequence":"additional","affiliation":[{"name":"Center for Liver Disease and Transplantation, New York, New York, USA"},{"name":"Liver Transplant and Hepatobiliary Surgery, Weill Cornell Medical College, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Samstein","sequence":"additional","affiliation":[{"name":"Center for Liver Disease and Transplantation, New York, New York, USA"},{"name":"Liver Transplant and Hepatobiliary Surgery, Weill Cornell Medical College, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA"},{"name":"Center for Liver Disease and Transplantation, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3981-7053","authenticated-orcid":false,"given":"Russell","family":"Rosenblatt","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA"},{"name":"Center for Liver Disease and Transplantation, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,7,30]]},"reference":[{"key":"R1-20250824","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1001\/jamainternmed.2018.6536","article-title":"National trends and long\u2010term outcomes of liver transplant for alcohol\u2010associated liver disease in the United States","volume":"179","year":"2019","journal-title":"JAMA Intern Med"},{"issue":"Suppl 1","key":"R2-20250824","first-page":"193","article-title":"OPTN\/SRTR 2018 Annual data report: liver","volume":"20","year":"2020","journal-title":"Am J Transplant"},{"key":"R3-20250824","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.drugalcdep.2014.12.016","article-title":"Changes in alcohol consumption: United States, 2001\u20132002 to 2012\u20132013","volume":"148","year":"2015","journal-title":"Drug Alcohol Depend"},{"key":"R4-20250824","article-title":"Mortality due to cirrhosis and liver cancer in the United States, 1999\u20132016: observational study","volume":"362","year":"2018","journal-title":"BMJ"},{"key":"R5-20250824","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1056\/NEJMoa1105703","article-title":"Early liver transplantation for severe alcoholic hepatitis","volume":"365","year":"2011","journal-title":"N Engl J Med"},{"key":"R6-20250824","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1053\/j.gastro.2018.04.009","article-title":"Outcomes of early liver transplantation for patients with severe alcoholic hepatitis","volume":"155","year":"2018","journal-title":"Gastroenterology"},{"issue":"9","key":"R7-20250824","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1002\/lt.22108","article-title":"Racial and ethnic disparities in access to liver transplantation","volume":"16","year":"2010","journal-title":"Liver Transpl"},{"key":"R8-20250824","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1002\/lt.25964","article-title":"A review of the current state of liver transplantation disparities","volume":"27","year":"2021","journal-title":"Liver Transpl"},{"key":"R9-20250824","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1097\/TP.0000000000002843","article-title":"Gender disparities in patients with alcoholic liver disease evaluated for liver transplantation","volume":"104","year":"2020","journal-title":"Transplantation"},{"issue":"2","key":"R10-20250824","article-title":"Alcohol and liver function in women","volume":"40","year":"2020","journal-title":"Alcohol Res"},{"key":"R11-20250824","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1038\/nrgastro.2018.8","article-title":"Women and alcoholic liver disease \u2010\u2010 warning of a silent danger","volume":"15","year":"2018","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"R12-20250824","doi-asserted-by":"crossref","first-page":"460","DOI":"10.4254\/wjh.v7.i3.460","article-title":"Gender\u2010based disparities in access to and outcomes of liver transplantation","volume":"7","year":"2015","journal-title":"World J Hepatol"},{"key":"R13-20250824","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/acer.13944","article-title":"Gender disparities in alcohol use disorder treatment among privately insured patients with alcohol\u2010associated cirrhosis","volume":"43","year":"2019","journal-title":"Alcohol Clin Exp Res"},{"key":"R14-20250824","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1111\/acer.14082","article-title":"Is there a recent epidemic of women's drinking? A critical review of national studies","volume":"43","year":"2019","journal-title":"Alcohol Clin Exp Res"},{"key":"R15-20250824","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1111\/ctr.12374","article-title":"Combination of racial\/ethnic and etiology\/disease\u2010specific factors is associated with lower survival following liver transplantation in African Americans: an analysis from UNOS\/OPTN database","volume":"28","year":"2014","journal-title":"Clin Transplant"},{"key":"R16-20250824","first-page":"229","article-title":"Focus on: ethnicity and the social and health harms from drinking","volume":"35","year":"2013","journal-title":"Alcohol Res"},{"key":"R17-20250824","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1002\/hep.31837","article-title":"Black patients have unequal access to listing for liver transplantation in the United States","volume":"74","year":"2021","journal-title":"Hepatology (Baltimore, Md)"},{"key":"R18-20250824","doi-asserted-by":"crossref","first-page":"2879","DOI":"10.1111\/ajt.14421","article-title":"Sociodemographic determinants of waitlist and posttransplant survival among end\u2010stage liver disease patients","volume":"17","year":"2017","journal-title":"Am J Transplant"},{"key":"R19-20250824","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.jclinepi.2017.12.006","article-title":"Linear regression and the normality assumption","volume":"98","year":"2018","journal-title":"J Clin Epidemiol"},{"key":"R20-20250824","first-page":"81","article-title":"Comorbidity of alcoholism and psychiatric disorders: An overview","volume":"26","year":"2002","journal-title":"Alcohol Res Health"},{"key":"R21-20250824","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1111\/ajt.13586","article-title":"Early liver transplantation for severe alcoholic hepatitis in the United States\u2014a single\u2010center experience","volume":"16","year":"2016","journal-title":"Am J Transplant"},{"key":"R22-20250824","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jsat.2018.05.003","article-title":"Misconceptions, preferences and barriers to alcohol use disorder treatment in alcohol\u2010related cirrhosis","volume":"91","year":"2018","journal-title":"J Subst Abuse Treat"},{"key":"R23-20250824","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s10620-013-2942-0","article-title":"Consequences of perceived stigma among patients with cirrhosis","volume":"59","year":"2014","journal-title":"Dig Dis Sci"},{"key":"R24-20250824","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1111\/j.1600-6143.2007.01666.x","article-title":"Female liver transplant recipients with the same GFR as male recipients have lower MELD scores\u2014a systematic bias","volume":"7","year":"2007","journal-title":"Am J Transplant"},{"key":"R25-20250824","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1111\/ajt.14608","article-title":"Sex\u2010based disparities in delisting for being \"too sick\" for liver transplantation","volume":"18","year":"2018","journal-title":"Am J Transplant"},{"key":"R26-20250824","first-page":"55","article-title":"Gender and use of substance abuse treatment services","volume":"29","year":"2006","journal-title":"Alcohol Res Health"},{"key":"R27-20250824","article-title":"Sex and gender effects in recovery from alcohol use disorder","volume":"40","year":"2020","journal-title":"Alcohol Res"},{"key":"R28-20250824","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1111\/apt.12974","article-title":"Review article: the management of cirrhosis in women","volume":"40","year":"2014","journal-title":"Aliment Pharmacol Ther"},{"key":"R29-20250824","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1053\/j.gastro.2021.08.050","article-title":"MELD 3.0: the model for end\u2010stage liver disease updated for the modern era","volume":"161","year":"2021","journal-title":"Gastroenterology"},{"key":"R30-20250824","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.14309\/ajg.0000000000000643","article-title":"Gender matters: characteristics of hepatocellular carcinoma in women from a large, multicenter study in the United States","volume":"115","year":"2020","journal-title":"Am J Gastroenterol"},{"key":"R31-20250824","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1002\/lt.24452","article-title":"Role of patient factors, preferences, and distrust in health care and access to liver transplantation and organ donation","volume":"22","year":"2016","journal-title":"Liver Transpl"},{"key":"R32-20250824","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1002\/hep.31742","article-title":"Black patients with cirrhosis have higher mortality and lower transplant rates: results from a metropolitan cohort study","volume":"74","year":"2021","journal-title":"Hepatology"},{"key":"R33-20250824","article-title":"Predicting relapse in patients with severe alcohol use disorder: The role of alcohol insight and implicit alcohol associations","volume":"107","year":"2020","journal-title":"Addict Behav"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lt.26544","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lt.26544","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1002\/lt.26544","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T20:02:41Z","timestamp":1756065761000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1002\/lt.26544"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,30]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.26544","relation":{},"ISSN":["1527-6465"],"issn-type":[{"value":"1527-6465","type":"print"}],"subject":[],"published":{"date-parts":[[2022,7,30]]},"assertion":[{"value":"2022-02-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-14","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}