Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
Colorado School of Public Health, University of Colorado Denver, Aurora, CO.
Transplantation. 2022 Jan 1;106(1):129-137. doi: 10.1097/TP.0000000000003683.
This study aimed to compare the outcomes of hepatitis C virus (HCV) positive (+) female liver transplant recipients to HCV negative (-) female and HCV+ male recipients before and after the direct-acting-antiviral (DAA) era.
The United Network for Organ Sharing liver transplant database was retrospectively reviewed from 2002 to 2017. The DAA era was defined as ≥2014.
In the pre-DAA era, HCV+ female recipients had greater risk for graft failure compared with HCV+ male (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.01-1.11; P = 0.03) and HCV- female (HR, 1.51; 95% CI, 1.43-1.60; P < 0.001) recipients. In the post-DAA era, HCV+ female recipients had lower risk for graft failure compared with HCV+ male recipients (HR, 0.82; 95% CI, 0.70-0.97; P = 0.02) and equivalent outcomes to HCV- female recipients. HCV+ female recipients with graft failure had increased likelihood of graft failure due to disease recurrence compared with HCV+ male recipients in the pre-DAA era (odds ratio, 1.23; 95% CI, 1.08-1.39; P = 0.001) but not in the post-DAA era.
Although historically HCV+ female recipients were at disproportionately increased risk for graft failure and disease recurrence, this disparity has been eliminated in the DAA era.
本研究旨在比较丙型肝炎病毒（HCV）阳性（+）女性肝移植受者与 HCV 阴性（-）女性和 HCV+男性受者在直接作用抗病毒（DAA）时代前后的结局。
回顾性分析 2002 年至 2017 年美国器官共享网络肝移植数据库。DAA 时代定义为≥2014 年。
在 DAA 时代前，HCV+女性受者与 HCV+男性（风险比[HR]，1.06；95%置信区间[CI]，1.01-1.11；P=0.03）和 HCV-女性（HR，1.51；95%CI，1.43-1.60；P<0.001）受者相比，移植失败风险更高。在 DAA 时代后，HCV+女性受者与 HCV+男性受者相比，移植失败风险较低（HR，0.82；95%CI，0.70-0.97；P=0.02），与 HCV-女性受者的结果相当。在 DAA 时代前，HCV+女性受者移植失败的原因更有可能是疾病复发，而不是 HCV+男性受者（比值比，1.23；95%CI，1.08-1.39；P=0.001），但在 DAA 时代后并非如此。
尽管 HCV+女性受者在历史上移植失败和疾病复发的风险不成比例地增加，但在 DAA 时代，这种差异已经消除。
