Koh Jia Hong, Chee Douglas, Ng Cheng Han, Wijarnpreecha Karn, Muthiah Mark, Tan Darren Jun Hao, Lim Wen Hui, Zeng Rebecca Wenling, Koh Benjamin, Xuan Eunice Tan Xiang, Bonney Glenn, Iyer Shridhar, Young Dan Yock, Nakamura Toru, Takahashi Hirokazu, Noureddin Mazen, Siddiqui Mohammad Shadab, Simon Tracey G, Loomba Rohit, Huang Daniel Q
Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.
Division of Gastroenterology and Hepatology, University of Arizona College of Medicine, Phoenix, AZ.
Transplant Direct. 2024 Jun 20;10(7):e1642. doi: 10.1097/TXD.0000000000001642. eCollection 2024 Jul.
The cause of liver disease is changing, but its impact on liver transplantation (LT) for hepatocellular carcinoma (HCC) in women and men is unclear. We performed a nationwide study to assess the prevalence and posttransplant survival outcomes of the various causes of liver disease in women and men with HCC.
Data were obtained from the United Network for Organ Sharing database from 2000 to 2022. Data related to the listing, transplant, waitlist mortality, and posttransplant mortality for HCC were extracted. The proportion of HCC related to the various causes of liver disease among LT candidates and recipients and posttransplant survival were compared between women and men.
A total of 51 721 individuals (39 465 men, 12 256 women) with HCC were included. From 2000 to 2022, nonalcoholic steatohepatitis (NASH) was the fastest-growing cause of liver disease among female LT candidates with HCC ( < 0.01), followed by alcohol-associated liver disease. NASH overtook chronic hepatitis C as the leading cause of liver disease in 2020 and 2022 among waitlisted women and men with HCC, respectively. Female patients with HCC spent a significantly longer time on the LT waitlist compared with male patients (β: 8.73; 95% confidence interval [CI], 2.91-14.54). Female patients with HCC from alcohol-associated liver disease also have a lower probability of receiving LT (subdistribution hazard ratio: 0.90; 95% CI, 0.82-0.99). Among transplant recipients with NASH HCC, female sex was associated with lower posttransplant mortality compared with male sex (hazard ratio: 0.79; 95% CI, 0.70-0.89; < 0.01).
Women have a significantly longer waitlist duration compared with men. NASH is now the leading cause of liver disease among both female and male LT candidates and recipients with HCC.
肝脏疾病的病因正在发生变化，但其对女性和男性肝细胞癌（HCC）肝移植（LT）的影响尚不清楚。我们开展了一项全国性研究，以评估患有HCC的女性和男性中各种肝脏疾病病因的患病率及移植后生存结局。
数据取自器官共享联合网络数据库2000年至2022年的数据。提取了与HCC的登记、移植、等待名单死亡率和移植后死亡率相关的数据。比较了女性和男性LT候选者及接受者中与各种肝脏疾病病因相关的HCC比例以及移植后生存率。
共纳入51721例患有HCC的个体（39465例男性，12256例女性）。从2000年到2022年，非酒精性脂肪性肝炎（NASH）是患有HCC的女性LT候选者中增长最快的肝脏疾病病因（<0.01），其次是酒精性肝病。2020年和2022年，NASH分别超过慢性丙型肝炎，成为等待名单上患有HCC的女性和男性肝脏疾病的主要病因。与男性患者相比，患有HCC的女性患者在LT等待名单上花费的时间明显更长（β：8.73；95%置信区间[CI]，2.91 - 14.54）。来自酒精性肝病的患有HCC的女性患者接受LT的概率也较低（亚分布风险比：0.90；95%CI，0.82 - 0.99）。在患有NASH HCC的移植受者中，女性与男性相比移植后死亡率较低（风险比：0.79；95%CI，0.70 - 0.89；<0.01）。
与男性相比，女性在等待名单上的时间明显更长。NASH现在是患有HCC的女性和男性LT候选者及接受者中肝脏疾病的主要病因。
