# Psychosocial Trauma History Negatively Impacts Liver Transplant Access in Women with Chronic Liver Disease

## TL;DR

Women with a history of psychosocial trauma are less likely to be listed for liver transplants compared to women without such trauma, while no such difference is seen in men.

## Contribution

This study reveals gender-specific disparities in liver transplant access linked to psychosocial trauma history.

## Key findings

- Women with trauma history were less likely to be listed for liver transplant compared to women without trauma history.
- Women with trauma history were more likely to be removed from the liver transplant waitlist.
- Trauma history did not affect liver transplant outcomes in those who received a transplant.

## Abstract

Few studies have evaluated the impact of psychological trauma (mental, emotional, or physical) on liver transplant (LT) candidacy and outcomes.

We performed a single center retrospective analysis of patients who completed routine LT evaluation between October 2017 and June 2021. We identified the prevalence of psychological trauma history in men and women LT candidates and evaluated the association between trauma history and LT access. The primary outcome measure was listing for LT.

A total of 463 patients completed LT evaluation, of which 17% (n = 79) reported a history of trauma: 49 of 159 women and 30 of 304 men. Trauma history was significantly more common in women than in men (31% vs. 10%, p < 0.001). Women with trauma history were less likely to be listed for LT (80% vs. 93%, p = 0.016). Women with trauma history were also more likely to be removed from the LT waitlist (26% vs. 12%, p = 0.045); this persists when excluding patients removed for transfer to another center or for medical improvement (22% vs. 7%, p = 0.020). In contrast, listing for LT (87% vs. 86%, p = 0.973) and waitlist removal (12% vs. 10%, p = 0.766) did not differ in men with and without trauma history. In those that received a LT (n = 107), post-LT relapse, rejection, readmissions, and death did not differ in patients with (n=13)and without (n=94) trauma history.

Trauma history is associated with reduced access to LT in women but not men with chronic liver disease. Further studies are needed to understand the impact of psychological trauma on LT access and post-LT outcomes.