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Dig Liver Dis. 2015 Aug;47(8):689-94. doi: 10.1016/j.dld.2015.04.006. Epub 2015 Apr 16.

Recipient female gender is a risk factor for graft loss after liver transplantation for chronic hepatitis C: Evidence from the prospective Liver Match cohort.

Author information

1
Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy. Electronic address: luca.belli@ospedaleniguarda.it.
2
Liver Transplant Center, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Italy.
3
Department of Mathematics, Tor Vergata University Hospital, Rome, Italy.
4
Division of Digestive Diseases, "Maggiore" University Hospital, Milan, Italy.
5
Division of Gastroenterology, Sapienza University, Rome, Italy.
6
Liver Transplant Center, University Hospital, Modena, Italy.
7
Liver Transplant Center, University Hospital, Bologna, Italy.
8
Gastroenterology and Transplant Hepatology, San Giovanni XXIII Hospital, Bergamo, Italy.
9
Department of Emergency and Organ Transplantation, University Hospital, Bari, Italy.
10
Liver Transplant Center, University Hospital, Padua, Italy.
11
Department of Internal Medicine and Gastroenterology, Gemelli Hospital, Rome, Italy.
12
Mediterranean Institute for Transplant, Palermo, Italy.
13
Digestive Disease Section, University Hospital Milano Bicocca and Yale University Center, New Haven, USA.
14
Hepatology Unit, Tor Vergata University, Rome, Italy.

Abstract

BACKGROUND:

Female gender has been reported to be a risk factor for graft loss after liver transplantation for hepatitis C virus (HCV)-related cirrhosis but evidence is limited to retrospective studies.

AIMS:

To investigate the impact of recipient gender and donor/recipient gender mismatch on graft outcome.

METHODS:

We performed a survival analysis of a cohort of 1530 first adult transplants enrolled consecutively in Italy between 2007 and 2009 and followed prospectively. After excluding possible confounding factors (fulminant hepatitis, human immunodeficiency virus co-infection, non-viremic anti-HCV positive subjects), a total of 1394 transplant recipients (604 HCV-positive and 790 HCV-negative) were included.

RESULTS:

Five-year graft survival was significantly reduced in HCV-positive patients (64% vs 76%, p=0.0002); Cox analysis identified recipient female gender (HR=1.44, 95% CI 1.03-2.00, p=0.0319), Mayo clinic End stage Liver Disease score (every 10 units, HR=1.25, 95% CI 1.03-1.50; p=0.022), portal thrombosis (HR=2.40, 95% CI 1.20-4.79, p=0.0134) and donor age (every 10 years, HR=1.14, 95% CI 1.05-1.24, p=0.0024) as independent determinants of graft loss. All additional mortality observed among female recipients was attributable to severe HCV recurrence.

CONCLUSIONS:

This study unequivocally shows that recipient female gender unfavourably affects the outcome of HCV-infected liver grafts.

KEYWORDS:

Donor age; Graft loss; HCV; HCV recurrence; Liver transplantation; Recipient gender

PMID:
26055490
DOI:
10.1016/j.dld.2015.04.006
[Indexed for MEDLINE]

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