Although women with chronic hepatitis C virus (HCV) infection are at lower risk for developing cirrhosis, researchers who compared outcomes for men and women after having liver transplantation found that women have a significantly increased risk of overall graft loss and graft loss from recurrent HCV than men. "Given the higher rate of graft losses due to recurrent HCV and higher risk of developing advanced HCV, our results highlight the need for close monitoring of HCV disease progression after liver transplantation and the appropriate timing of interventions, such as HCV treatment," said Jennifer Lai, MD, lead investigator for the study.
In this study to be presented at the annual meeting of the American Association for the Study of Liver Diseases, data were analyzed from four experienced liver transplant centers in the United States, which included 850 patients who underwent liver transplantation from March 2002 through December 2007 for HCV-related liver disease. Not only were women at greater risk of graft loss from all causes and recurrent HCV, but they experienced increased rates of advanced HCV-related liver disease compared with men.
These differences were not explained by differences in baseline recipient or donor characteristics, or rates of acute rejection after transplantation. "However," said Dr. Lai, "understanding the factors contributing to this gender difference is critical to improving post-transplant outcomes for all patients with HCV."
Based on this multicenter study, further studies are needed to evaluate modifiable donor factors and post-transplant therapeutics that influence outcomes. There may be a future role for gender-specific models to optimize post-transplant outcomes in women. "Whether we should have a more intensive approach to monitoring for and management of recurrent HCV would improve outcomes in women will need to be established in future studies," said Dr. Lai.
In addition, Dr. Lai discussed future research on this topic, "We found recipient age to be a stronger predictor of outcome for women than for men, and we noted that women had higher rates of having a sex-mismatch donor liver than men. A more in depth analysis of the role of recipient-donor sex mismatch is planned. In addition, we found that women had significantly increased rates of acute rejection and although this factor did not account for differences in graft outcomes in our study, we believe sex differences in frequency of rejection and response to rejection treatment warrant further study."
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