Clinical

Female liver transplant recipients at higher risk for graft loss due to recurrent HCV

Last Updated: 2009-11-02 18:16:30 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - After liver transplantation for hepatitis C virus (HCV) cirrhosis, women in a recent study were at greater risk of graft loss than were men. Women also exhibited a trend towards decreased survival at 3 years.

The study results were presented yesterday in Boston at the annual meeting of the American Association for the Study of Liver Diseases.

Reappearance of HCV in the blood after transplant is virtually guaranteed. The current findings, said lead investigator Dr. Jennifer Lai, "highlight the need for close monitoring" of recurrence in the liver, as well as the appropriate timing of interventions, "such as anti-HCV treatment and...treatment of acute rejection."

Dr. Lai, from the University of California, San Francisco, and colleagues followed 839 patients (195 women, 644 men) transplanted at four major centers in the US between 2002 and 2007. All survived more than 30 days after transplant.

After a median follow-up of 3.1 years, graft loss from all causes was more frequent in women vs men (29.2% vs 24.1%), as was loss from recurrent HCV (12.3% vs 8.5%). There was a trend toward lower 3-year patient survival in the women, too (72.6% vs 77.6%).

On multivariate analysis, women were 45% more likely to experience graft loss from any cause, and 68% more likely to experience graft loss from recurrent HCV.

"This gender difference is strikingly different from the nontransplant setting," the researchers wrote in their study abstract.

The abstract also notes that at the time of transplant, the women had a lower median glomerular filtration rate compared to the men (55 vs 75 ml/min/1.73m2) and a higher rate of recipient-donor sex mismatch (49% vs 34%).

"Further studies are needed to determine the etiology of this gender difference," Dr. Lai said. "However, exploratory analyses of our data generated some interesting hypotheses."

"First, is there a differential effect of aging in women versus men on outcomes? Second, does sex mismatch influence outcomes for women more than men? Third, what is the effect of decreased pre-transplant renal function in women at the time of transplant on their post-transplant outcomes, particularly on immunosuppression and rates of acute rejection?"

"These are all important areas of future research that we hope to explore with an expanded and prospective cohort," Dr. Lai concluded.