Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 18, 2024; 14(1): 88133
Published online Mar 18, 2024. doi: 10.5500/wjt.v14.i1.88133
Impact of sex on the outcomes of deceased donor liver transplantation
Oya M Andacoglu, Isabel S Dennahy, Nicole C Mountz, Luisa Wilschrey, Arzu Oezcelik
Oya M Andacoglu, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah, Salt Lake City, UT 84112, United States
Oya M Andacoglu, Luisa Wilschrey, Arzu Oezcelik, Department of Surgery, University of Essen, Essen D-45122, Germany
Isabel S Dennahy, Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, United States
Nicole C Mountz, Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, OK 73117, United States
Author contributions: All authors contributed equally to this study.
Institutional review board statement: This study was deemed exempt by the Institutional Review Board of Essen University. All research referenced in this manuscript was conducted in accordance with institutional processes as well as both the Declarations of Helsinki and Istanbul.
Informed consent statement: As explained within the manuscript and document answering the reviewers directly, this study was deemed exempt by the Institutional Review Board of Essen University. Thus, no signed informed consent documents or IRB forms were needed to be obtained.
Conflict-of-interest statement: None of the authors have conflicts of interest.
Data sharing statement: Further data available from the corresponding author at dr.oyaandacoglu@gmail.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Oya M Andacoglu, MD, Assistant Professor, Doctor, Surgeon, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah, 30 N Mario Capecchi Drive, Salt Lake City, UT 84112, United States. dr.oyaandacoglu@gmail.com
Received: October 3, 2023
Peer-review started: October 3, 2023
First decision: October 17, 2023
Revised: November 1, 2023
Accepted: December 11, 2023
Article in press: December 11, 2023
Published online: March 18, 2024
Processing time: 163 Days and 16.4 Hours
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.