Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 18, 2024; 14(1): 88133
Published online Mar 18, 2024. doi: 10.5500/wjt.v14.i1.88133
Impact of sex on the outcomes of deceased donor liver transplantation
Oya M Andacoglu, Isabel S Dennahy, Nicole C Mountz, Luisa Wilschrey, Arzu Oezcelik
Oya M Andacoglu, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah, Salt Lake City, UT 84112, United States
Oya M Andacoglu, Luisa Wilschrey, Arzu Oezcelik, Department of Surgery, University of Essen, Essen D-45122, Germany
Isabel S Dennahy, Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, United States
Nicole C Mountz, Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, OK 73117, United States
Author contributions: All authors contributed equally to this study.
Institutional review board statement: This study was deemed exempt by the Institutional Review Board of Essen University. All research referenced in this manuscript was conducted in accordance with institutional processes as well as both the Declarations of Helsinki and Istanbul.
Informed consent statement: As explained within the manuscript and document answering the reviewers directly, this study was deemed exempt by the Institutional Review Board of Essen University. Thus, no signed informed consent documents or IRB forms were needed to be obtained.
Conflict-of-interest statement: None of the authors have conflicts of interest.
Data sharing statement: Further data available from the corresponding author at dr.oyaandacoglu@gmail.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Oya M Andacoglu, MD, Assistant Professor, Doctor, Surgeon, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah, 30 N Mario Capecchi Drive, Salt Lake City, UT 84112, United States. dr.oyaandacoglu@gmail.com
Received: October 3, 2023
Peer-review started: October 3, 2023
First decision: October 17, 2023
Revised: November 1, 2023
Accepted: December 11, 2023
Article in press: December 11, 2023
Published online: March 18, 2024
Processing time: 163 Days and 16.4 Hours
Abstract
BACKGROUND

Data examining the impact of sex on liver transplant (LT) outcomes are limited. It is clear that further research into sex-related differences in transplant patients is necessary to identify areas for improvement. Elucidation of these differences may help to identify specific areas of focus to improve on the organ matching process, as well as the peri- and post-operative care of these patients.

AIM

To utilize data from a high-volume Eurotransplant center to compare characteristics of male and female patients undergoing liver transplant and assess association between sex-specific variables with short- and long-term post-transplant outcomes.

METHODS

A retrospective review of the University of Essen’s transplant database was performed with collection of baseline patient characteristics, transplant-related data, and short-term outcomes. Comparisons of these data were made with Shapiro-Wilk, Mann-Whitney U, χ2 and Bonferroni tests applied where appropriate. A P value of < 0.05 was accepted as statistically significant.

RESULTS

Of the total 779 LT recipients, 261 (33.5%) were female. Female patients suffered higher incidences of acute liver failure and lower incidences of alcohol-related or viremic liver disease (P = 0.001). Female patients were more likely to have received an organ from a female donor with a higher donor risk index score, and as a high urgency offer (all P < 0.05). Baseline characteristics of male and female recipients were also significantly different. In multivariate hazard regression analysis, recipient lab-Model for End-Stage Liver Disease score and donor cause of death were associated with long-term outcomes in females. Pre-operative diagnosis of hepatocellular carcinoma, age at time of listing, duration of surgery, and units transfused during surgery, were associated with long-term outcomes in males. Severity of complications was associated with long-term outcomes in both groups. Overall survival was similar in both males and females; however, when stratified by age, females < 50 years of age had the best survival.

CONCLUSION

Female and male LT recipients have different baseline and transplant-related characteristics, with sex-specific variables which are associated with long-term outcomes. Female recipients < 50 years of age demonstrated the best long-term outcomes. Pre- and post-transplant practices should be individualized based on sex-specific variables to optimize long-term outcomes.

Keywords: Liver transplant; Outcomes; Survival; Peri- and post-operative care

Core Tip: Within this retrospective review, we evaluated baseline and transplant-related features of both male and female liver transplant recipients. Our results identify several sex-specific variables that affect long-term outcomes of liver transplantation, including statistically significant survival outcomes seen in females under the age of 50.