Dehne Sarah, Jackson-Gil Lorena, Riede Carlo, Feisst Manuel, Mehrabi Arianeb, Michalski Christoph W, Weigand Markus A, Decker Sebastian O, Larmann Jan
Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany.
Heidelberg University, Institute of Medical Biometry, Heidelberg, Germany.
Front Med (Lausanne). 2024 Sep 23;11:1452733. doi: 10.3389/fmed.2024.1452733. eCollection 2024.
Differences in medical treatment between women and men are common and involve out-of-hospital emergency care, the intensity of pain treatment, and the use of antifibrinolytic treatment in emergency trauma patients. If woman and man receive different antifibrinolytic treatment in highly-standardized major transplant surgery is unknown.
We conducted a retrospective cohort study on patients who underwent liver transplantation at Heidelberg University Hospital, Heidelberg, Germany between 2004 and 2017. Logistic regression analyses were performed to determine if sex is associated with the administration of TXA during liver transplantation. Secondary endpoints included venous thrombotic complications, graft failure, mortality, myocardial infarction, hepatic artery thrombosis, and stroke within the first 30 days after liver transplant as well as length of hospital stay and length of intensive care unit stay.
Out of 779 patients who underwent liver transplantation, 262 patients received TXA. Female sex was not associated with intraoperative administration of TXA [adjusted OR: 0.929 (95% CI 0.654; 1.320), = 0.681]. The secondary endpoints graft failure (13.2% vs. 8.4%, women vs. men, = 0.039), pulmonary embolism (3.4% vs. 0.9%, women vs. men, = 0.012), stroke (1.7% vs. 0.4%, women vs. men, = 0.049), and deep vein thrombosis (0.8% vs. 0%, women vs. men, = 0.031) within 30 days after liver transplantation were more frequent in women. Mortality, myocardial infarction, and other secondary endpoints did not differ between groups. However, in women, the use of TXA was associated with a lower rate in thromboembolic complications.
Our data indicate that different from other scenarios with massive bleeding complications the administration of TXA during liver transplantation is not associated with sex. However, sex is associated with the risk for complications, and in woman TXA might have a preventive effect on the rate of thromboembolic complications. Reasons underlying the observed sex bias rate remain uncertain.
男女在医疗治疗方面的差异很常见，包括院外急救、疼痛治疗强度以及急诊创伤患者抗纤维蛋白溶解治疗的使用。在高度标准化的大型移植手术中，男女是否接受不同的抗纤维蛋白溶解治疗尚不清楚。
我们对2004年至2017年期间在德国海德堡大学医院接受肝移植的患者进行了一项回顾性队列研究。进行逻辑回归分析以确定性别是否与肝移植期间氨甲环酸（TXA）的使用有关。次要终点包括肝移植后30天内的静脉血栓并发症、移植失败、死亡率、心肌梗死、肝动脉血栓形成和中风，以及住院时间和重症监护病房住院时间。
在779例接受肝移植的患者中，262例患者接受了TXA。女性与术中使用TXA无关[调整后的比值比：0.929（95%置信区间0.654；1.320），P = 0.681]。次要终点中，肝移植后30天内女性的移植失败（13.2%对8.4%，女性对男性，P = 0.039）、肺栓塞（3.4%对0.9%，女性对男性，P = 0.012）、中风（1.7%对0.4%，女性对男性，P = 0.049）和深静脉血栓形成（0.8%对0%，女性对男性，P = 0.031）更为常见。死亡率、心肌梗死和其他次要终点在各组之间没有差异。然而，在女性中，使用TXA与血栓栓塞并发症的发生率较低有关。
我们的数据表明，与其他有大量出血并发症的情况不同，肝移植期间TXA的使用与性别无关。然而，性别与并发症风险有关，在女性中TXA可能对血栓栓塞并发症的发生率有预防作用。观察到的性别偏倚率背后的原因仍不确定。
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