Recipient female gender is a risk factor for graft loss after liver transplantation for chronic hepatitis C: Evidence from the prospective Liver Match cohort

Abstract Background Female gender has been reported to be a risk factor for graft loss after liver transplantation for hepatitis C virus (HCV)-related cirrhosis but evidence is limited to retrospective studies. Aims To investigate the impact of recipient gender and donor/recipient gender mismatch on...

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Bibliographic Details
Published in:Digestive and liver disease 2015-08, Vol.47 (8), p.689-694
Main Authors: Belli, Luca Saverio, Romagnoli, Renato, Nardi, Alessandra, Marianelli, Tania, Donato, Francesca, Corradini, Stefano Ginanni, Iemmolo, Rosa Maria, Morelli, Cristina, Pasulo, Luisa, Rendina, Maria, De Martin, Eleonora, Ponziani, Francesca Romana, Volpes, Riccardo, Strazzabosco, Mario, Angelico, Mario
Format: Article
Language:English
Subjects:
Age Factors
Donor age
End Stage Liver Disease - surgery
Female
Gastroenterology and Hepatology
Graft loss
Graft Survival
HCV
HCV recurrence
Hepacivirus - genetics
Hepatitis C, Chronic - surgery
Humans
Liver Transplantation
Male
Middle Aged
Portal Vein
Proportional Hazards Models
Prospective Studies
Recipient gender
Recurrence
Risk Factors
RNA, Viral - blood
Severity of Illness Index
Sex Factors
Survival Rate
Thrombosis - complications
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Summary:Abstract Background Female gender has been reported to be a risk factor for graft loss after liver transplantation for hepatitis C virus (HCV)-related cirrhosis but evidence is limited to retrospective studies. Aims To investigate the impact of recipient gender and donor/recipient gender mismatch on graft outcome. Methods We performed a survival analysis of a cohort of 1530 first adult transplants enrolled consecutively in Italy between 2007 and 2009 and followed prospectively. After excluding possible confounding factors (fulminant hepatitis, human immunodeficiency virus co-infection, non-viremic anti-HCV positive subjects), a total of 1394 transplant recipients (604 HCV-positive and 790 HCV-negative) were included. Results Five-year graft survival was significantly reduced in HCV-positive patients (64% vs 76%, p = 0.0002); Cox analysis identified recipient female gender (HR = 1.44, 95% CI 1.03–2.00, p = 0.0319), Mayo clinic End stage Liver Disease score (every 10 units, HR = 1.25, 95% CI 1.03–1.50; p = 0.022), portal thrombosis (HR = 2.40, 95% CI 1.20–4.79, p = 0.0134) and donor age (every 10 years, HR = 1.14, 95% CI 1.05–1.24, p = 0.0024) as independent determinants of graft loss. All additional mortality observed among female recipients was attributable to severe HCV recurrence. Conclusions. This study unequivocally shows that recipient female gender unfavourably affects the outcome of HCV-infected liver grafts.
ISSN:1590-8658
1878-3562
DOI:10.1016/j.dld.2015.04.006