Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN.
Ann Surg. 2018 Dec;268(6):1043-1050. doi: 10.1097/SLA.0000000000002318.
To evaluate the relationship between donor sex and hepatocellular carcinoma (HCC) recurrence after living donor liver transplantation.
HCC shows a male predominance in incidence and recurrence after tumor resection due to sex differences in hepatic sex hormone receptors. There have been no studies evaluating the importance of donor sex on post-transplant HCC recurrence.
Of 384 recipients of livers, from living donors, for HCC: 104/120 who received grafts from female donors were matched with 246/264 who received grafts from male donors using propensity score matching, with an unfixed matching ratio based on factors like tumor biology. Survival analysis was performed with death as a competing risk event. The primary outcome was overall HCC recurrence.
The median follow-up time was 39 months. Before matching, recurrence probability at 1/2/5 years after transplantation was 6.1/9.7/12.7% in recipients with female donors and 11.7/19.2/25.3% in recipients with male donors. Recurrence risk was significantly higher with male donors in univariable analysis (hazard ratio [HR] = 2.04 [1.15-3.60], P = 0.014) and multivariable analysis (HR=2.10 [1.20-3.67], P = 0.018). In the matched analysis, recurrence risk was also higher with male donors (HR=1.92 [1.05-3.52], P = 0.034): both in intrahepatic recurrence (HR=1.92 [1.05-3.51], P = 0.034) and extrahepatic recurrence (HR=1.93 [1.05-3.52], P = 0.033). Multivariable analysis confirmed the significance of donor sex (HR=2.08 [1.11-3.91], P = 0.023). Interestingly, the significance was lost when donor age was >40 years. Two external cohorts validated the significance of donor sex.
Donor sex appears to be an important graft factor modulating HCC recurrence after living donor liver transplantation.
评估供体性别与活体肝移植后肝细胞癌（HCC）复发之间的关系。
由于肝性激素受体的性别差异，HCC 在肿瘤切除术后的发病率和复发率均表现为男性居多。目前尚无研究评估供体性别对移植后 HCC 复发的重要性。
在 384 例接受活体供肝的 HCC 患者中：104 例/120 例接受女性供体移植物的患者与 246 例/264 例接受男性供体移植物的患者进行了倾向性评分匹配，匹配比例不固定，基于肿瘤生物学等因素。采用死亡作为竞争风险事件进行生存分析。主要结局是总体 HCC 复发。
中位随访时间为 39 个月。在匹配之前，女性供体组患者在移植后 1/2/5 年的复发概率分别为 6.1%/9.7%/12.7%，男性供体组患者分别为 11.7%/19.2%/25.3%。单变量分析（风险比[HR] = 2.04[1.15-3.60]，P = 0.014）和多变量分析（HR=2.10[1.20-3.67]，P = 0.018）均显示男性供体的复发风险显著更高。在匹配分析中，男性供体的复发风险也更高（HR=1.92[1.05-3.52]，P = 0.034）：无论是肝内复发（HR=1.92[1.05-3.51]，P = 0.034）还是肝外复发（HR=1.93[1.05-3.52]，P = 0.033）。多变量分析证实了供体性别（HR=2.08[1.11-3.91]，P = 0.023）的重要性。有趣的是，当供体年龄>40 岁时，这种显著性丧失。两个外部队列验证了供体性别（sex）的重要性。
供体性别似乎是活体肝移植后调节 HCC 复发的一个重要移植物因素。
