Marked Sex Differences Seen in Outcome After Liver Transplant for Hepatitis C Virus Infection

Megan Brooks

November 09, 2009

November 9, 2009 (Boston, Massachusetts) — In a contemporary cohort of hepatitis C virus (HCV)-infected liver transplant patients, women had a 46% increased risk for mortality, a 39% increased risk for graft loss, a 44% increased risk for advanced recurrent HCV disease, and an 83% increased risk for graft loss from recurrent HCV disease, compared with men.

Jennifer C. Lai, MD, from the University of California at San Francisco, reported the data here at The Liver Meeting 2009: American Association for the Study of Liver Diseases 60th Annual Meeting.

In her plenary presentation, Dr. Lai said that "female sex represents a previously unrecognized risk factor for graft loss and recurrent HCV infection. There may be a future role for gender-specific models to optimize posttransplant outcomes in women."

Her team's findings are based on a comparison of posttransplant outcomes for 195 women and 655 men who were transplanted for HCV-related liver disease between March 1, 2002 and December 31, 2007, and who survived at least 30 days after transplant.

Overall graft survival at 3 years was 73% for women and 78% for men. At 5 years, graft survival was 63% for women and 73% for men. "In unadjusted analysis, this did not quite meet statistical significance, but in multivariate analysis, recipient female sex was an independent predictor of graft loss, with a hazard ratio of 1.39," Dr. Lai reported.

She also noted that significantly more women than men experienced at least 1 episode of treated acute rejection, although this factor did not account for differences in graft outcomes. Rates of cytomegalovirus infection were similar for men and women, as were rates of posttransplant antiviral treatment.

In an unadjusted analysis, there was a trend toward decreased patient survival in women, compared with men. The 3-year patient survival rate was 76% for women and 81% for men. The 5-year patient survival rate was 66% for women and 76% for men.

"In multivariate analysis, recipient female sex emerged as an independent predictor of mortality," Dr. Lai said. Recipient female sex was also significantly and independently associated with advanced recurrent disease and graft loss with advanced recurrent disease.

"Although our study was not designed to elucidate the etiology of this gender difference, exploratory analyses of our data did generate some interesting and important hypotheses," Dr. Lai told the conference. First, there was "a differential effect of aging in women vs men, resulting in higher mortality and HCV recurrence."

Second, a "sex mismatch contributes to graft outcomes, recognizing that women have higher rates of sex mismatch [than] men in our cohort."

Last, she noted that pretransplant renal dysfunction influences the risk for HCV recurrence and women in this study had more renal dysfunction at the time of transplant.

Marina Berenguer, MD, from the Hepatogastroenterology Service, Hospital Universitario La Fe in Valencia, Spain, who moderated the session, told Medscape Gastroenterology that "this is a good study that needs follow-up; it has to be confirmed. The numbers of women were quite small, compared with the numbers of men, and the study did not provide information on levels of immunosuppression in women and men. Women are smaller and maybe they are more immunosuppressed."

The study did not receive commercial support. Dr. Lai and Dr. Berenguer have disclosed no relevant financial relationships.

The Liver Meeting 2009: American Association for the Study of Liver Diseases (AASLD) 60th Annual Meeting: Abstract 6. Presented November 1, 2009.

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