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已故供体肝移植后的性别特异性生存率:一项回顾性队列研究。

Gender specific survival rates after deceased donor liver transplantation: A retrospective cohort.

作者信息

Gabbay Uri, Issachar Assaf, Cohen-Naftaly Michal, Brown Marius, Nesher Eviatar

机构信息

Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.

Quality Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.

出版信息

Ann Med Surg (Lond). 2022 Jun 5;79:103933. doi: 10.1016/j.amsu.2022.103933. eCollection 2022 Jul.


DOI:10.1016/j.amsu.2022.103933
PMID:35860137
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9289308/
Abstract

BACKGROUND: According to the literature, there are sex allocation inequalities in liver transplantation (LT). Sex disparities in outcomes after LT have been debated. This study aimed to evaluate sex-specific outcomes after LT, specifically short-term mortality and long-term survival rates. METHODS: A retrospective cohort of the entire LT series from to 2010-2019 in a single center in which the inclusion criteria were adults ≥18 YO age who underwent primary deceased donor LT. Mortality rate was evaluated within 30 days and 6 months. Survival rate was evaluated at 1,3 and 5 years of age. RESULTS: A total of 240 primary and deceased donor LTs (153 men and 87 women) were included. Mean age 55.2Y men and 51.6Y women (p = 0.02). Hepatocellular carcinoma (HCC) was the direct indication in 32.7% of the men and only 17.4% of the women. The leading primary liver morbidities were viral hepatitis (B, C, and D) in 38.3% (N = 92) and nonalcoholic steatohepatitis (NASH) in 20.8% (N = 50) of patients. Thirty-day mortality was 14%, which was significantly higher in men (18%) than in women (8%). Survival rates after 5 years were 64.9% and 78.3%, respectively. Multivariate analysis through logistic regression that included age, direct indication, MELD, and primary liver morbidity revealed statistically significant female to male Odds-Ratio of 0.4 in 30 days, 6 m mortality and a statistically significant higher long-term survival. CONCLUSIONS: Our observations revealed better female outcomes, namely, lower short-term mortality and higher long-term survival. Given the consistency after stratification and given the multivariate analysis, this is unlikely to be attributable to confounders. Such findings suggesting consistently better female outcomes have not been previously reported; hence, multi center study is encouraged.

摘要

背景:根据文献,肝移植(LT)中存在性别分配不平等现象。肝移植术后的性别差异一直存在争议。本研究旨在评估肝移植术后的性别特异性结局,特别是短期死亡率和长期生存率。 方法:对2010年至2019年在单个中心进行的整个肝移植系列进行回顾性队列研究,纳入标准为年龄≥18岁接受初次脑死亡供体肝移植的成年人。在30天和6个月内评估死亡率。在1、3和5年时评估生存率。 结果:共纳入240例初次脑死亡供体肝移植患者(153例男性和87例女性)。男性平均年龄55.2岁,女性平均年龄51.6岁(p = 0.02)。肝细胞癌(HCC)是32.7%男性的直接指征,而女性仅为17.4%。主要的原发性肝脏疾病是38.3%(N = 92)的患者为病毒性肝炎(B、C和D型),20.8%(N = 50)的患者为非酒精性脂肪性肝炎(NASH)。30天死亡率为14%,男性(18%)显著高于女性(8%)。5年后的生存率分别为64.9%和78.3%。通过逻辑回归进行的多变量分析包括年龄、直接指征、终末期肝病模型(MELD)和原发性肝脏疾病,结果显示在30天、6个月死亡率方面,女性与男性的统计学显著优势比为0.4,且长期生存率在统计学上显著更高。 结论:我们的观察结果显示女性结局更好,即短期死亡率更低,长期生存率更高。考虑到分层后的一致性以及多变量分析结果,这不太可能归因于混杂因素。此前尚未报道过此类表明女性结局始终更好的研究结果;因此,鼓励开展多中心研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ccc1/9289308/a8580f2fc20c/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ccc1/9289308/a8580f2fc20c/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ccc1/9289308/a8580f2fc20c/gr1.jpg

相似文献

[1]
Gender specific survival rates after deceased donor liver transplantation: A retrospective cohort.

Ann Med Surg (Lond). 2022-6-5

[2]
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[3]
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[4]
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[5]
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[6]
Live donor liver transplantation for patients with hepatocellular carcinoma offers increased survival vs. deceased donation.

J Hepatol. 2019-1-8

[7]
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Am J Gastroenterol. 2018-6-8

[8]
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Transplant Proc. 2015

[9]
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[10]
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引用本文的文献

[1]
Sex-based disparities in liver transplantation: Evidence from a nationwide Italian cohort.

JHEP Rep. 2025-3-7

[2]
Recipient-Donor Sex Constellation in Liver Transplantation for Hepatocellular Carcinoma-An ELTR Study.

Liver Int. 2025-1

[3]
Impact of sex on the outcomes of deceased donor liver transplantation.

World J Transplant. 2024-3-18

[4]
De Novo Metabolic Syndrome 1 Year after Liver Transplantation and Its Association with Mid- and Long-Term Morbidity and Mortality in Liver Recipients.

J Clin Med. 2024-3-16

[5]
(Bio)printing in Personalized Medicine-Opportunities and Potential Benefits.

Bioengineering (Basel). 2023-2-23

本文引用的文献

[1]
STROCSS 2021: Strengthening the reporting of cohort, cross-sectional and case-control studies in surgery.

Int J Surg. 2021-12

[2]
Influence of donor and recipient gender on liver transplantation outcomes in Europe.

Liver Int. 2020-8

[3]
Incidence, Predictors, and Impact on Survival of Long-term Cardiovascular Events After Liver Transplantation.

Transplantation. 2020-2

[4]
The Impact of Preexisting and Post-transplant Diabetes Mellitus on Outcomes Following Liver Transplantation.

Transplantation. 2019-12

[5]
New-onset obesity after liver transplantation-outcomes and risk factors: the Swiss Transplant Cohort Study.

Transpl Int. 2018-7-9

[6]
Reduced Access to Liver Transplantation in Women: Role of Height, MELD Exception Scores, and Renal Function Underestimation.

Transplantation. 2018-10

[7]
Gender, Race and Disease Etiology Predict De Novo Malignancy Risk After Liver Transplantation: Insights for Future Individualized Cancer Screening Guidance.

Transplantation. 2019-1

[8]
Estrogen-Estrogen Receptor α Signaling Facilitates Bilirubin Metabolism in Regenerating Liver Through Regulating Cytochrome P450 2A6 Expression.

Cell Transplant. 2017-11

[9]
Sex-based disparities in delisting for being "too sick" for liver transplantation.

Am J Transplant. 2017-12-28

[10]
Liver transplantation for chronic hepatitis C virus infection in the United States 2002-2014: An analysis of the UNOS/OPTN registry.

PLoS One. 2017-10-31

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