Gabbay Uri, Issachar Assaf, Cohen-Naftaly Michal, Brown Marius, Nesher Eviatar
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.
Ann Med Surg (Lond). 2022 Jun 5;79:103933. doi: 10.1016/j.amsu.2022.103933. eCollection 2022 Jul.
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.
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.
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.
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.
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。
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。
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。
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。
