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World J Transplant. Dec 24, 2014; 4(4): 229-242
Published online Dec 24, 2014. doi: 10.5500/wjt.v4.i4.229
Female gender in the setting of liver transplantation
Kryssia Isabel Rodríguez-Castro, Eleonora De Martin, Martina Gambato, Silvia Lazzaro, Erica Villa, Patrizia Burra
Kryssia Isabel Rodríguez-Castro, Eleonora De Martin, Martina Gambato, Silvia Lazzaro, Patrizia Burra, Multivisceral Transplant Unit, Deparment of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
Erica Villa, Department of Gastroenterology, Azienda Ospedaliero-Universitaria and University of Modena and Reggio Emilia, 41124 Modena, Italy
Author contributions: Rodríguez-Castro KI contributed to the conception, design, and performance of the research, drafting of the manuscript, approval of the final version; De Martin E contributed to the conception, design, and performance of the research, drafting of the manuscript, approval of the final version; Gambato M contributed to the critical revision of the manuscript, approval of the final version; Lazzaro S critically revised the manuscript, approval of the final version; Villa E contributed to the conception and design of the research, critical revision of the manuscript, approval of the final version; Burra P contributed to the conception and design of the research, critical revision of the manuscript, approval of the final version.
Correspondence to: Patrizia Burra, Professor, MD, PhD, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, 35128 Padua, Italy. burra@unipd.it
Telephone: +39-49-8212892 Fax: +39-49-8218727
Received: April 8, 2014
Revised: May 27, 2014
Accepted: July 15, 2014
Published online: December 24, 2014
Processing time: 264 Days and 22.3 Hours
Abstract

The evolution of liver diseases to end-stage liver disease or to acute hepatic failure, the evaluation process for liver transplantation, the organ allocation decision-making, as well as the post-transplant outcomes are different between female and male genders. Women’s access to liver transplantation is hampered by the use of model for end-stage liver disease (MELD) score, in which creatinine values exert a systematic bias against women due to their lower values even in the presence of variable degrees of renal dysfunction. Furthermore, even when correcting MELD score for gender-appropriate creatinine determination, a quantifiable uneven access to transplant prevails, demonstrating that other factors are also involved. While some of the differences can be explained from the epidemiological point of view, hormonal status plays an important role. Moreover, the pre-menopausal and post-menopausal stages imply profound differences in a woman’s physiology, including not only the passage from the fertile age to the non-fertile stage, but also the loss of estrogens and their potentially protective role in delaying liver fibrosis progression, amongst others. With menopause, the tendency to gain weight may contribute to the development of or worsening of pre-existing metabolic syndrome. As an increasing number of patients are transplanted for non-alcoholic steatohepatitis, and as the average age at transplant increases, clinicians must be prepared for the management of this particular condition, especially in post-menopausal women, who are at particular risk of developing metabolic complications after menopause.

Keywords: Liver transplantation; Female gender; Estrogens; Model for end-stage liver disease score; Creatinine; Gender donor-recipient match

Core tip: Gender differences play an important role in liver diseases, their evolution and outcome, and in liver transplantation, not only in terms of access to this resource, but also in terms of graft survival, metabolic aspects, and quality of life after liver transplantation. Not only gender differences, are important, however, but clearly the different hormonal status throughout a woman’s lifetime determines many aspects not only regarding fertility and sexual issues such as pregnancy, but also metabolic complications. Notwithstanding this, decision-making algorithms regarding indications, risk factors, and outcomes after transplant do not yet incorporate many of these concepts that affect the clinical practice.