Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Liver Transpl. 2010 Oct;16(10):1147-57. doi: 10.1002/lt.22121.
Previous studies of men and women on the liver transplantation (LT) waiting list, without taking transplantation rates into account, have suggested a higher risk of mortality for women on the waiting list. The objective of this study was to compare men and women with respect to dying within 3 years of registration on the LT waiting list and to take into account both the immediate mortality risks and the transplantation rates. The analysis was based on Organ Procurement and Transplantation Network data for patients with end-stage liver disease (ESLD) on the waiting list who were registered between February 2002 and August 2009. Competing risk survival analysis was performed to assess the gender disparity in waiting-list mortality; 42,322 patients and 610,762 person-months of waiting-list experience were included in the analysis. The risk of dying within 3 years of listing was 19% and 17% in women and men, respectively (P < 0.0001). Among patients with kidney disease and especially those not on dialysis with an estimated glomerular filtration rate (eGFR) ≥15 and <30 mL/minute/1.73 m(2), women had a substantially higher risk of dying on the waiting list within 3 years of registration versus men (26% versus 20%, P = 0.001). This disparity was related to lower transplantation rates in women (transplantation rate ratio = 0.68, P < 0.0001). Controlling for eGFR and other variables related to mortality risk, we found that the overall female-male disparity disappeared. In conclusion, among patients with ESLD and kidney dysfunction who are not on dialysis, there is a substantial gender disparity in LT waiting-list mortality. Our analysis suggests as an explanation the fact that women have lower transplantation rates than men in this group. The lower transplantation rates can be explained in part by the fact that Model for End-Stage Liver Disease scores tend to be lower for women versus men because they are based on serum creatinine rather than the glomerular filtration rate.
先前对接受肝移植（LT）的男性和女性进行的研究（未考虑移植率）表明，等待名单上的女性死亡率更高。本研究的目的是比较男性和女性在登记 LT 等待名单后 3 年内死亡的情况，并同时考虑即时死亡率和移植率。该分析基于 2002 年 2 月至 2009 年 8 月期间登记在等待名单上的终末期肝病（ESLD）患者的器官采购和移植网络数据。采用竞争风险生存分析评估等待名单死亡率的性别差异；共有 42322 名患者和 610762 人月的等待名单经验纳入分析。女性在登记后 3 年内死亡的风险为 19%，男性为 17%（P < 0.0001）。在患有肾脏疾病的患者中，尤其是那些未接受透析且估计肾小球滤过率（eGFR）≥15 且<30 mL/min/1.73 m2的患者中，女性在登记后 3 年内等待名单上死亡的风险明显高于男性（26%比 20%，P = 0.001）。这种差异与女性较低的移植率有关（移植率比=0.68，P < 0.0001）。控制 eGFR 和其他与死亡率相关的变量后，我们发现总体女性与男性的差异消失。总之，在未接受透析且有肾脏功能障碍的 ESLD 患者中，LT 等待名单死亡率存在明显的性别差异。我们的分析表明，造成这种差异的一个原因是该组女性的移植率低于男性。女性的移植率较低部分是因为终末期肝病模型评分往往低于男性，因为评分基于血清肌酐而不是肾小球滤过率。
