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Meta-analysis of donor–recipient gender profile in paediatric living donor liver transplantation
  1. Zhen Yu Wong1,
  2. Zhi Rong Low1,
  3. Yong Chen2,
  4. Mahmoud Danaee3,
  5. Shireen Anne Nah1
  1. 1Division of Paediatric & Neonatal Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  2. 2Department of Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore
  3. 3Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  1. Correspondence to Professor Shireen Anne Nah, Division of Paediatric & Neonatal Surgery, Department of Surgery, University of Malaya Faculty of Medicine, Kuala Lumpur, Wilayah Persekutuan, Malaysia; shireen.nah{at}


Objective Paediatric living donor liver transplantation (LDLT) has gained popularity due to limited deceased donor organ supply. Some studies report inequalities in donor and recipient gender profiles, but data are sparse. We evaluated LDLT donor–recipient gender profiles, comparing country income categories and gender disparity level.

Design We performed a systematic review, searching PubMed, Embase and Cochrane databases for publications dated January 2006–September 2021. We included full-text English articles reporting gender in ≥40 universally sampled donor–recipient pairs. Search terms were permutations of ‘liver transplant’, ‘living donor’ and ‘paediatric’. Countries were grouped as high/middle/low-income economies based on World Bank criteria and into groups based on deviation from gender parity in Gender Development Index (GDI) values (group 1 indicating closest to gender parity, group 5 indicating furthest). Proportions analysis with corresponding 95% CI were used for analysis of dichotomous variables, with significance when 95% CI did not cross 0.5. Data are reported as female proportion (%) and 95% CI.

Results Of 12 525 studies identified, 14 retrospective studies (12 countries; 6152 recipients and 6138 donors) fulfilled study inclusion criteria. Male recipient preponderance was seen in lower middle-income countries (all were also GDI group 5) (39.3 (95% CI 34.7 to 44.0)) and female recipient preponderance in GDI groups 1 and 3. Female donor preponderance was seen overall (57.4% (95% CI 55.1 to 59.6)), in middle income countries and in three of four GDI groups represented.

Conclusion There are significant imbalances in recipient-donor gender profiles in paediatric LDLT that are not well explained. The reasons for overall female donor preponderance across income tiers must be scrutinised.

  • Healthcare Disparities
  • Economics
  • Paediatrics
  • Global Health
  • Epidemiology

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  • Contributors ZYW and SAN had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design (ZYW and SAN); acquisition of the data (ZYW and ZRL); analysis and interpretation of the data (ZYW, ZRL, YC and MD); drafting of the manuscript (SAN, ZYW and ZRL); critical revision of the manuscript for important intellectual content (SAN, YC and MD); study supervision (SAN). SAN accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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