Department of Hepatology, Loyola University Medical Center, Maywood, IL, USA.
Loyola University Chicago, Maywood, IL, USA.
Clin Transplant. 2018 Aug;32(8):e13297. doi: 10.1111/ctr.13297. Epub 2018 Jul 19.
Nonalcoholic steatohepatitis (NASH) is the fastest growing indication for liver transplantation (LT). Data from the UNOS database were used to compare rates of listing and LT between men and women with NASH.
The study population consisted of 76 149 patients listed for LT between 2005 and 2012, 5 492 (7.2%) of who were listed for NASH. Patient characteristics and outcomes were compared by gender.
Nonalcoholic steatohepatitis was a more frequent indication for transplant listing in women than men throughout the study period. Women had lower serum creatinine levels at listing (1.18 ± 0.76 mg/dL vs 1.28 ± 0.79 mg/dL, P < .001) and were less likely to be listed with exception points (17.7% vs 24.9%, P < .001). Transplantation was less common among women than men with NASH (52.4% vs 64.3%), and women were more likely to experience death on the waiting list (17.1% vs 11.4%) In multivariable analysis adjusting for covariates, the rate of LT remained lower for women with NASH (aHR 0.81 95% CI: 0.75-0.88).
Women with NASH cirrhosis had a higher risk of death on the LT waiting list and were less likely to receive LT compared to men.
非酒精性脂肪性肝炎（NASH）是肝移植（LT）增长最快的适应证。本研究利用 UNOS 数据库的数据比较了男性和女性 NASH 患者的 LT 登记率和 LT 率。
研究人群包括 2005 年至 2012 年间登记进行 LT 的 76149 例患者，其中 5492 例（7.2%）患者因 NASH 而登记。通过性别比较患者特征和结局。
在整个研究期间，NASH 作为 LT 登记的适应证在女性中比男性更为常见。女性在登记时的血清肌酐水平较低（1.18 ± 0.76 mg/dL 比 1.28 ± 0.79 mg/dL，P <.001），且不太可能因例外积分而登记（17.7%比 24.9%，P <.001）。与男性相比，患有 NASH 的女性接受 LT 的可能性较低（52.4%比 64.3%），且更有可能在等待名单上死亡（17.1%比 11.4%）。在多变量分析中，调整协变量后，NASH 女性的 LT 率仍然较低（aHR 0.81，95%CI：0.75-0.88）。
与男性相比，患有 NASH 肝硬化的女性在 LT 等待名单上死亡的风险更高，且更不可能接受 LT。
