Impact of sex on the outcomes of deceased donor liver transplantation

ARTICLE HIGHLIGHTS

Research background

Female liver transplant recipients generally demonstrate comparable, if not better, outcomes than males across a number of etiologies. However, due to lack of access, female patients are getting progressively sicker while waiting and risk being removed from the transplant list while their male counterparts undergo successful transplant (14-18). Further research into sex-based differences in transplant patients is paramount in identifying areas of improvement. Defining these differences may lead to focused improvement on the organ-matching process and more specific management of peri- and post-operative care of male and female recipients.

Research motivation

Female and male transplant candidates demonstrate different characteristics, which have a complex interplay to influence access to liver transplant as well as transplant outcomes. Herein, we demonstrate sex-based differences in disease etiology, comorbidity profile and donor characteristics. In addition, we demonstrated specific factors with differential impact on the survival of each sex after liver transplant. These should be considered as tools to improve the system, and adjustments to the allocation process could reduce the disparities between males and females.

Research objectives

The aim of this study was to utilize data from a high-volume Eurotransplant center to compare characteristics of male and female patients undergoing liver transplant and assess association between sex-specific variables with short- and long-term post-transplant outcomes.

Research methods

A retrospective review of the University of Essen’s transplant database was performed with collection of baseline patient characteristics, transplant-related data, and short-term outcomes. Comparisons of these data were made with Shapiro-Wilk, Mann-Whitney U, χ² and Bonferroni tests applied where appropriate. A P value of < 0.05 was accepted as statistically significant.

Research results

There were significant differences in baseline characteristics between male and female recipients. Female patients suffered more from acute liver failure and less from alcohol-related or viremic liver disease (P = 0.001). Female patients were more likely to receive an organ from a female donor, with a higher donor risk index score, and as a high urgency offer (all P < 0.05). On multivariate hazard regression analysis, patient lab-MELD score and donor cause of death were associated with differences in long-term outcomes for females. A pre-operative diagnosis of hepatocellular carcinoma, increased age at time of listing, high urgency status of transplant, duration of surgery, and higher number of units transfused during surgery were all associated with differences in long-term outcomes for males.

Research conclusions

Through this retrospective review, we have demonstrated sex-based differences in disease etiology, comorbidity profile and donor characteristics as well as specific factors with differential impact on the survival of each sex after liver transplant. These should be considered as tools to improve the system, and adjustments to the allocation process could reduce the disparities between males and females. Lastly, perioperative care of females with chronic liver disease may differ from males. Thus, management and follow up of liver transplant patients should be individualized, with consideration of sex-specific variables.

Research perspectives

Further research should aim to focus to optimize long-term outcomes between male and female liver transplant recipients.