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Salah M, Montasser IF, El-Gendy HA, Korraa AA, Elewa GM, Dabbous H, Abdelrahman M, Goda MH, Bahaa MM, El Meteini M, Labib HA. Donor gender effect on graft function in adult Egyptian patients undergoing living donor liver transplantation: A single centre study. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2060643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Manar Salah
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Iman F. Montasser
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hanaa A. El-Gendy
- Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alaa A. Korraa
- Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Gamal M. Elewa
- Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hany Dabbous
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mostafa Abdelrahman
- Department of General Surgery and Liver Transplantation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohammed Hisham Goda
- Department of General Surgery and Liver Transplantation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed M. Bahaa
- Department of General Surgery and Liver Transplantation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud El Meteini
- Department of General Surgery and Liver Transplantation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba A. Labib
- Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Nguyen LS, Coutance G, Salem JE, Ouldamar S, Lebreton G, Combes A, Amour J, Laali M, Leprince P, Varnous S. Effect of recipient gender and donor-specific antibodies on antibody-mediated rejection after heart transplantation. Am J Transplant 2019; 19:1160-1167. [PMID: 30286278 DOI: 10.1111/ajt.15133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 08/21/2018] [Accepted: 09/23/2018] [Indexed: 01/25/2023]
Abstract
Gender-difference regarding antibody-mediated rejection (AMR) after heart transplantation has been described. However, no study accounted for the presence of preformed donor-specific antibodies (pfDSA), a known risk factor of AMR, more common among women than men. In a single-institution 6-year cohort (2010-2015), time to AMR was assessed, comparing men with women by survival analysis with a 1-year death-censored follow-up. All AMRs were biopsy proven. Confounding variables that were accounted for included mean intensity fluorescence (MFI) of pfDSA, recipient age, HLA-, size- and sex-mismatch. 463 patients were included. Overall incidence of AMR was 10.3% at 1 year. After adjusting for confounding variables, independent risk factors of AMR were female recipient gender (adjusted hazard-ratio [adj. HR] = 1.78 [1.06-2.99]), P = .03) and the presence of pfDSA (adj. HR = 3.20 [1.80-5.70], P < .001). This association remained significant when considering pfDSA by their MFI; female recipient gender had an adj. HR = 2.2 (P = .026) and MFI of pfDSA (per 1 MFI-increase) adj. HR = 1.0002 (P < .0001). In this cohort, women were at higher risk of AMR than men and this risk increase was additive to that of pfDSA. These findings may suggest a gender-related difference in the severity of pfDSA.
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Affiliation(s)
- Lee S Nguyen
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France.,APHP, Pitié-Salpétrière, Sorbonne University, Center of Clinical Investigation, ICAN, Paris, France
| | - Guillaume Coutance
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
| | - Joe-Elie Salem
- APHP, Pitié-Salpétrière, Sorbonne University, Center of Clinical Investigation, ICAN, Paris, France.,Department of Medicine, Clinical Pharmacology, Cardio-oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Salima Ouldamar
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
| | - Guillaume Lebreton
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
| | - Alain Combes
- APHP, Pitié-Salpétrière, Sorbonne University, Intensive Care Medicine Department, ICAN, Paris, France
| | - Julien Amour
- APHP, Pitié-Salpétrière, Sorbonne University, Anesthesiology & Critical Care Medicine Department, Paris, France
| | - Mojgan Laali
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
| | - Pascal Leprince
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
| | - Shaida Varnous
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
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Triantos C, Aggeletopoulou I, Kalafateli M, Spantidea PI, Vourli G, Diamantopoulou G, Tapratzi D, Michalaki M, Manolakopoulos S, Gogos C, Kyriazopoulou V, Mouzaki A, Thomopoulos K. Prognostic significance of vitamin D receptor (VDR) gene polymorphisms in liver cirrhosis. Sci Rep 2018; 8:14065. [PMID: 30218108 PMCID: PMC6138740 DOI: 10.1038/s41598-018-32482-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023] Open
Abstract
Several polymorphisms in the vitamin D receptor (VDR) are associated with the occurrence of chronic liver disease. Here, we investigated the association between BsmI, ApaI, TaqI and FokI VDR polymorphisms and the severity of liver cirrhosis in relation to serum cytokine and lipopolysaccharide binding protein (LBP) levels and their role on survival in cirrhotic patients. We found that patients harboring the BB genotype had higher MELD score, and they were mainly at CP stage C; patients harboring the AA genotype had increased LBP, IL-1β and IL-8 levels, and they were mostly at CP stage C; TT genotype carriers had higher MELD score and they were mainly at CP stage C and FF genotype carriers had lower IL-1β levels when compared to Bb/bb, Aa/aa, Tt/tt and Ff/ff genotypes respectively. In the multivariate analysis ApaI, BsmI and TaqI polymorphisms were independently associated with liver cirrhosis severity. In the survival analysis, the independent prognostic factors were CP score, MELD and the FF genotype. Our results indicate that the ApaI, TaqI and BsmI polymorphisms are associated with the severity of liver cirrhosis, through the immunoregulatory process. Survival is related to the FF genotype of FokI polymorphism, imparting a possible protective role in liver cirrhosis.
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Affiliation(s)
- Christos Triantos
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
| | | | - Maria Kalafateli
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece
| | - Panagiota I Spantidea
- Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Georgia Vourli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | | | - Dimitra Tapratzi
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece
| | - Marina Michalaki
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Internal Medicine, University of Patras, Patras, Greece
| | - Spilios Manolakopoulos
- 2nd Department of Internal Medicine, Hippokration General Hospital of Athens, 11527, Athens, Greece
| | - Charalambos Gogos
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Venetsana Kyriazopoulou
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Internal Medicine, University of Patras, Patras, Greece
| | - Athanasia Mouzaki
- Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
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4
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Hussein MH, Hashimoto T, Suzuki T, Abdel-Hamid Daoud G, Kato T, Hibi M, Tomishige H, Hara F, Ito T, Kato I, Kazuhiko K, Sobajima H, Tamura M, Togari H. Liver Transplantation from Female Donors Provokes Higher Complement Component C5a Activity. Ann Transplant 2017; 22:694-700. [PMID: 29162794 PMCID: PMC6248037 DOI: 10.12659/aot.905464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Transplanted organs from female donors are associated with less favorable prognoses and outcomes. This study aimed to determine whether donor gender affects levels of serum terminal complement component C5a and oxidative stress in pediatric living related liver transplantation (LRLTx) recipients. Material/Methods The subjects were 43 patients (20 males and 23 females) who underwent LRLTx during childhood (age range 1.2 years to 14.4 years; mean age 5 years). Serum samples were taken during the patients’ regular outpatient visits after LRLTx. Serum C5a was measured using the specific human C5a ELISA kit. Serum total hydroperoxide (TH) and biological antioxidative potential (BAP) were measured using the free radical analytic system, and the oxidative stress index (OSI) was calculated as the ratio of TH to BAP. Serum glutamic pyruvic transaminase (GPT), glutamic oxaloacetic transaminase (GOT), gamma-glutamyl transpeptidase (γGTP), and lactate dehydrogenase (LDH) were also measured as part of a typical outpatient examination for such patients. Results C5a serum levels were higher in the 29 recipients who received their grafted livers from female donors than in the 14 recipients who received their grafted livers from male donors. Recipients who received their grafted livers from female donors had higher incidence of post-LTx (liver transplantation) complications. Female recipients from female donors showed the highest serum GPT and GOT levels, but this difference was only significant when compared to the female recipients from male donors (41.4±9.8 IU/L vs. 17.3±1.8 IU/L for GPT and 42.2±7.5 IU/L vs. 23.4±2.2 IU/L for GOT; P<0.05). Conclusions Pediatric LRLTx patients who receive their grafts from female donors exhibit higher levels of serum C5a that probably plays a role in the immunological response against grafted livers from female donors in LTx.
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Affiliation(s)
- Mohamed Hamed Hussein
- Division of Neonatology, Center of Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe, Saitama, Japan.,Department of Pediatric Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takashi Hashimoto
- Department of General and Pediatric Surgery, Masuko Memorial Hospital, Nakamura, Nagoya, Japan.,Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho, Nagoya, Japan
| | - Tatsuya Suzuki
- Department of Pediatric Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | | | - Takazumi Kato
- Department of Pediatric Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masahito Hibi
- Department of Pediatric Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hirokazu Tomishige
- Department of Pediatric Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Fujio Hara
- Department of Pediatric Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Tetsuya Ito
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Ineko Kato
- Department of Perinatal Development and Preventive Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kabe Kazuhiko
- Division of Neonatology, Center of Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe, Saitama, Japan
| | - Hisanori Sobajima
- Division of Neonatology, Center of Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe, Saitama, Japan
| | - Masanori Tamura
- Division of Neonatology, Center of Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe, Saitama, Japan
| | - Hajime Togari
- , Kinjogakuin University, Moriyama-ku, Nagoya, Aichi, Japan
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Lactate serum concentrations during treatment with nucleos(t)ide analogues in hepatitis B with or without cirrhosis. Eur J Gastroenterol Hepatol 2017; 29:998-1003. [PMID: 28746158 DOI: 10.1097/meg.0000000000000924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the clinical implications of lactate concentrations in patients with hepatitis B with or without cirrhosis during treatment with nucleos(t)ide analogues. PATIENTS AND METHODS One hundred and seven consecutive patients with chronic hepatitis B and median age 57 (24-85) years were prospectively included. Lactate concentrations were measured at baseline and at 12, 24, 36, 48, and 60 months following the baseline measurements. Eight (n=8, 7.5%) patients received lamivudine, 38 (n=38, 35.5%) patients received tenofovir, 34 (n=34, 31.8%) patients received entecavir, and 27 (n=27, 25.2%) patients received combined therapy. RESULTS None of the patients developed lactic acidosis during follow-up [median: 58 (6-155) months]. Overall, no trends of the lactic acid evolution were observed over time; however, there was a nonsignificant increasing trend in patients with cirrhosis up to 24 months of treatment. This increasing trend was significant in female patients with cirrhosis (P=0.016). The age of the patients, the presence of cirrhosis, and hepatocellular carcinoma were strongly associated with the survival of all patients. In the group of cirrhotic patients, the only independent prognostic factor that was associated with patients' survival was the Child-Pugh class. CONCLUSION None of the patients developed lactic acidosis. There is an indication of an increasing trend of lactic acid levels up to 24 months of therapy in female cirrhotic patients.
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Puoti F, Ricci A, Nanni-Costa A, Ricciardi W, Malorni W, Ortona E. Organ transplantation and gender differences: a paradigmatic example of intertwining between biological and sociocultural determinants. Biol Sex Differ 2016; 7:35. [PMID: 27471591 PMCID: PMC4964018 DOI: 10.1186/s13293-016-0088-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/19/2016] [Indexed: 11/20/2022] Open
Abstract
Organ transplantation, e.g., of the heart, liver, or kidney, is nowadays a routine strategy to counteract several lethal human pathologies. From literature data and from data obtained in Italy, a striking scenario appears well evident: women are more often donors than recipients. On the other hand, recipients of organs are mainly males, probably reflecting a gender bias in the incidence of transplant-related pathologies. The impact of sex mismatch on transplant outcome remains debated, even though donor-recipient sex mismatch, due to biological matters, appears undesirable in female recipients. In our opinion, the analysis of how sex and gender can interact and affect grafting success could represent a mandatory task for the management of organ transplantation.
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Affiliation(s)
- Francesca Puoti
- National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Andrea Ricci
- National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | | | - Walter Ricciardi
- National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy ; Section of Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Walter Malorni
- Section of Gender Medicine, Istituto Superiore di Sanità, Rome, Italy ; Department of Therapeutic Research and Medicine Evaluation, Section of Cell Aging and Degeneration, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy
| | - Elena Ortona
- Section of Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
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Aufhauser DD, Wang Z, Murken DR, Bhatti TR, Wang Y, Ge G, Redfield RR, Abt PL, Wang L, Svoronos N, Thomasson A, Reese PP, Hancock WW, Levine MH. Improved renal ischemia tolerance in females influences kidney transplantation outcomes. J Clin Invest 2016; 126:1968-77. [PMID: 27088798 DOI: 10.1172/jci84712] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/05/2016] [Indexed: 01/25/2023] Open
Abstract
Experimentally, females show an improved ability to recover from ischemia-reperfusion injury (IRI) compared with males; however, this sex-dependent response is less established in humans. Here, we developed a series of murine renal ischemia and transplant models to investigate sex-specific effects on recovery after IRI. We found that IRI tolerance is profoundly increased in female mice compared with that observed in male mice and discovered an intermediate phenotype after neutering of either sex. Transplantation of adult kidneys from either sex into a recipient of the opposite sex followed by ischemia at a remote time resulted in ischemia recovery that reflected the sex of the recipient, not the donor, revealing that the host sex determines recovery. Likewise, renal IRI was exacerbated in female estrogen receptor α-KO mice, while female mice receiving supplemental estrogen before ischemia were protected. We examined data from the United Network for Organ Sharing (UNOS) to determine whether there is an association between sex and delayed graft function (DGF) in patients who received deceased donor renal transplants. A multivariable logistic regression analysis determined that there was a greater association with DGF in male recipients than in female recipients. Together, our results demonstrate that sex affects renal IRI tolerance in mice and humans and indicate that estrogen administration has potential as a therapeutic intervention to clinically improve ischemia tolerance.
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8
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Gu XQ, Zheng WP, Teng DH, Sun JS, Zheng H. Impact of non-oncological factors on tumor recurrence after liver transplantation in hepatocellular carcinoma patients. World J Gastroenterol 2016; 22:2749-2759. [PMID: 26973413 PMCID: PMC4777997 DOI: 10.3748/wjg.v22.i9.2749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/13/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary neoplasm of the liver and is one of the leading causes of cancer-related death worldwide. Liver transplantation (LT) has become one of the best curative therapeutic options for patients with HCC, although tumor recurrence after LT is a major and unaddressed cause of mortality. Furthermore, the factors that are associated with recurrence are not fully understood, and most previous studies have focused on the biological properties of HCC, such as the number and size of the HCC nodules, the degree of differentiation, the presence of hepatic vascular invasion, elevated serum levels of alpha-fetoprotein, and the tumor stage outside of the Milan criteria. Thus, little attention has been given to factors that are not directly related to HCC (i.e., “non-oncological factors”), which have emerged as predictors of tumor recurrence. This review was performed to assess the effects of non-oncological factors on tumor recurrence after LT. The identification of these factors may provide new research directions and clinical strategies for the prophylaxis and surveillance of tumor recurrence after LT, which can help reduce recurrence and improve patient survival.
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9
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Rodríguez-Castro KI, De Martin E, Gambato M, Lazzaro S, Villa E, Burra P. Female gender in the setting of liver transplantation. World J Transplant 2014; 4:229-242. [PMID: 25540733 PMCID: PMC4274594 DOI: 10.5500/wjt.v4.i4.229] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/27/2014] [Accepted: 07/15/2014] [Indexed: 02/05/2023] Open
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.
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10
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Croome KP, Segal D, Hernandez-Alejandro R, Adams PC, Thomson A, Chandok N. Female donor to male recipient gender discordance results in inferior graft survival: a prospective study of 1,042 liver transplants. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:269-74. [PMID: 24123790 DOI: 10.1002/jhbp.40] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The influence of donor-recipient gender mismatch on outcomes after liver transplantation (LT) is controversial. The aim of this study was to evaluate the effect of donor and recipient gender discordance on graft survival. METHODS All patients who underwent primary LT from 1994-2012 at a single-center were identified prospectively. Clinico-demographic data were collected at the time of LT and last follow-up. Gender match included both male donor to male recipient (MM) and female donor to female recipient (FF), while gender mismatch included female donor to male recipient (FM) and male donor to female recipient (MF). Survival curves for graft survival were generated using Kaplan-Meier method and compared by log-rank test. Unadjusted and multivariate adjusted COX regression analyzing graft survival at up to 10 years post-transplant was performed. RESULTS A total of 1,042 subjects fulfilled the criteria. Graft survival in patients receiving a donor-recipient gender match was better than those receiving a gender mismatch (P = 0.047). Female-to-male transplants had the worst graft survival of all combinations (P < 0.001); this difference was maintained in multivariate regression after adjustment for recipient and donor variables (hazards ratio 2.09, P = 0.013). CONCLUSION Female-to-male liver transplants are associated with a statistically significant poorer graft survival as compared with other donor-recipient gender groups.
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11
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Burra P, De Martin E, Gitto S, Villa E. Influence of age and gender before and after liver transplantation. Liver Transpl 2013; 19:122-34. [PMID: 23172830 DOI: 10.1002/lt.23574] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 11/08/2012] [Indexed: 12/15/2022]
Abstract
Women constitute a particular group among patients with chronic liver disease and in the post-liver transplantation (LT) setting: they are set apart not only by traditional differences with respect to men (ie, body mass index, different etiologies of liver disease, and accessibility to transplantation) but also in increasingly evident ways related to hormonal changes that characterize first the fertile age and subsequently the postmenopausal period (eg, disease course variability and responses to therapy). The aim of this review is, therefore, to evaluate the role of the interplay of factors such as age, gender, and hormones in influencing the natural history of chronic liver disease before and after LT and their importance in determining outcomes after LT. As the population requiring LT ages and the mean age at transplantation increases, older females are being considered for transplantation. Older patients are at greater risk for nonalcoholic steatohepatitis, osteoporosis, and a worse response to antiviral therapy. Female gender per se is associated with a greater risk for osteoporosis because of metabolic changes after menopause, the bodily structure of females, and, in the population of patients with chronic liver disease, the greater prevalence of cholestatic and autoimmune liver diseases. With menopause, the fall of protective estrogen levels can lead to increased fibrosis progression, and this represents a negative turning point for women with chronic liver disease and especially for patients with hepatitis C. Therefore, the notion of gender as a binary female/male factor is now giving way to the awareness of more complex disease processes within the female gender that follow hormonal, social, and age patterns and need to be addressed directly and specifically.
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Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy.
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12
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Li C, Wen TF, Yan LN, Li B, Yang JY, Xu MQ, Wang WT, Wei YG. Scoring selection criteria including total tumour volume and pretransplant percentage of lymphocytes to predict recurrence of hepatocellular carcinoma after liver transplantation. PLoS One 2013; 8:e72235. [PMID: 23991069 PMCID: PMC3749102 DOI: 10.1371/journal.pone.0072235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/08/2013] [Indexed: 02/05/2023] Open
Abstract
AIM The selection criteria for patients with hepatocellular carcinoma (HCC) to undergo liver transplantation should accurately predict posttransplant recurrence while not denying potential beneficiaries. In the present study, we attempted to identify risk factors associated with posttransplant recurrence and to expand the selection criteria. PATIENTS AND METHODS Adult patients with HCC who underwent liver transplantation between November 2004 and September 2012 at our centre were recruited into the current study (N = 241). Clinical and pathological data were retrospectively reviewed. Patients who died during the perioperative period or died of non-recurrence causes were excluded from this study (N = 25). All potential risk factors were analysed using uni- and multi-variate analyses. RESULTS Sixty-one recipients of 216 qualified patients suffered from recurrence. Similar recurrence-free and long-term survival rates were observed between living donor liver transplant recipients (N = 60) and deceased donor liver transplant recipients (N = 156). Total tumour volume (TTV) and preoperative percentage of lymphocytes (L%) were two independent risk factors in the multivariate analysis. We propose a prognostic score model based on these two risk factors. Patients within our criteria achieved a similar recurrence-free survival to patients within the Milan criteria. Seventy-one patients who were beyond the Milan criteria but within our criteria also had comparable survival to patients within the Milan criteria. CONCLUSIONS TTV and L% are two risk factors that contribute to posttransplant recurrence. Selection criteria based on these two factors, which are proposed by our study, expanded the Milan criteria without increasing the risk of posttransplant recurrence.
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Affiliation(s)
- Chuan Li
- Division of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Tian-Fu Wen
- Division of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
- * E-mail:
| | - Lu-Nan Yan
- Division of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Bo Li
- Division of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Jia-Ying Yang
- Division of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Ming-Qing Xu
- Division of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Wen-Tao Wang
- Division of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yong-Gang Wei
- Division of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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Li C, Wen TF, Yan LN, Li B, Yang JY, Wang WT, Xu MQ, Wei YG. Predictors of patient survival following living donor liver transplantation. Hepatobiliary Pancreat Dis Int 2011; 10:248-53. [PMID: 21669566 DOI: 10.1016/s1499-3872(11)60041-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Living donor liver transplantation (LDLT) is considered to be the alterative choice in light of the great shortage of cadaveric donors. However, the characteristics of the patients who will benefit from LDLT have not been well identified. The aim of this study was to define the pre- and intra-operative factors that may influence patient outcome. METHODS The data from 102 LDLT patients who had operations between 2002 and 2009 were collected and analyzed retrospectively. Data were analyzed using uni- and multi-variate analysis according to factors that are known to be associated with outcome in these patients. RESULTS Overall, the accurate survival rate of recipients at 1, 3, and 5 years was 84%, 76%, and 70%, respectively. The independent risk factors, preoperative renal dysfunction, intraoperative red blood cell transfusions of greater than 5 units, and female to male match (donor to recipient matching), were identified by Cox regression analysis. The pre-transplant model for end-stage liver disease score and a graft to recipient weight ratio of less than 0.8% were not predictive of outcome. The overall 1-, 3-, and 5-year survival of patients with one or no risk factors and two or more risk factors were 91%, 86%, and 83% and 67%, 56%, and 47%, respectively (P<0.0001). CONCLUSIONS In our retrospective study, preoperative renal dysfunction, intraoperative red blood cell transfusions of greater than 5 units, and female to male gender match were independent risk factors for LDLT recipient outcome. Two or more of these risk factors may contribute to poor outcome.
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Affiliation(s)
- Chuan Li
- Division of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China
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Aytaman A, Kaufman M, Terrault NA. Management of posttransplant hepatitis C infection. Curr Opin Organ Transplant 2010; 15:301-9. [PMID: 20445452 DOI: 10.1097/mot.0b013e3283398237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Chronic hepatitis C virus (HCV) infection is the leading cause of liver transplantation. Outcome of HCV-associated liver transplantation has been worse than transplantation from other causes. This is mostly related to universal recurrence of HCV in the allograft leading to graft and patient loss or retransplantation. Current antiviral therapies (AVTs) are inadequate and ineffective in the vast majority of the patients with intolerable side effects in most. However, a sustained virologic response (SVR) is associated with improved graft and patient survival. New specifically targeted AVTs for HCV (STAT-C) agents in development will significantly improve the success of AVT. This review focuses on recent data in peritransplant management of HCV with special emphasis on predictors of outcome, diagnosis, prevention and control of reinfection with newer treatments on the horizon. RECENT FINDINGS In the immediate pretransplant setting, AVT should be considered in select patients to eradicate the virus. Careful donor selection, immunosuppression (IMS) modulation with steroid and calcineurin inhibitor (CNI) minimization, avoidance of T-cell-depleting treatments and acute rejection episodes, and control of metabolic syndrome can improve allograft outcomes and improve the response to AVT. AVT prior to significant damage to the allograft is strongly recommended. SUMMARY With modified novel IMS protocols, careful donor selection, and AVT prior to significant damage to the allograft we can improve the outcome of posttransplant hepatitis C infection. Albeit there are no available data on new antiviral agents, STAT-Cs will have a significant impact in this setting in the near future.
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Affiliation(s)
- Ayse Aytaman
- VA New York Harbor HCS Brooklyn, Brooklyn, New York 11209, USA.
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Lehner F, Becker T, Klempnauer J, Borlak J. Gender-incompatible liver transplantation is not a risk factor for patient survival. Liver Int 2009; 29:196-202. [PMID: 18673439 DOI: 10.1111/j.1478-3231.2008.01827.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS Clinical data may be suggestive for differences in patient survival in gender-incompatible orthotopic liver transplantation (OLT), but findings are inconsistent and are putatively linked to circulating hormones. We therefore investigated patient survival as well as metabolism of steroids to identify possible causes of improved graft survival in gender-mismatched OLT. METHODS We examined our single-centre database of 1355 recipients of first liver transplants for overall patient survival by non-parametric and parametric analysis of multivariance taking the age of recipient and donor, ischaemia time, underlying liver disease and the time period of transplantation into account. Furthermore, the metabolism of androgens in gender-incompatible OLT was studied in cultures of primary human hepatocytes obtained from male and female patients. RESULTS Unlike previous studies we were unable to determine overall significant differences in patient survival in gender-incompatible OLT, even though a statistically significant improved patient survival was observed when male donor livers were transplanted into female recipients in univariant analysis (P=0.047). However, when the overall patient management was taken into account no difference in survival was determined in multivariant analysis. Importantly, the metabolism of testosterone did not differ between male and female hepatocyte cultures, except for the production of 6-alpha-hydroxy-testosterone (P<0.001). CONCLUSIONS Taken collectively, clinical observations may tend to suggest a slightly improved patient survival in gender-incompatible OLT but this cannot be explained on the bases of androgen metabolism. Overall, we view gender-incompatible liver transplantation not to be a confounder in patient survival after OLT.
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Affiliation(s)
- Frank Lehner
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
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Soric S, Belanger MP, Askin N, Wittnich C. Impact of female sex hormones on liver tissue lactic acidosis during ischemia. Transplantation 2007; 84:763-70. [PMID: 17893610 DOI: 10.1097/01.tp.0000280542.61123.ec] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lower liver transplant success is observed when the donor is female. Intracellular acidosis during ischemia is proposed to contribute to the injury sustained by the transplanted organ and its role in livers obtained from nonheartbeating donors is unclear. Research has shown that livers of female rats develop a greater degree of intracellular acidosis during ischemia than males. This work explores the role of sex hormones in mediating this sex difference. METHODS Subgroups of neutered female rats were given 17 beta-estradiol (E), progesterone (P), or combination (E+P). To compare the effects of female sex hormones in males, subgroups of intact and castrated males received 17 beta-estradiol. In vivo and ischemic liver biopsies were taken and analyzed for lactate and H. RESULTS Although there was no effect of hormone therapy on baseline metabolic parameters, during ischemia compared to neutered females, livers from E females significantly (P<0.01) increased lactate by 56% and H+ by 71%, while E+P significantly increased only lactate (39%; P<0.05). Livers from neutered males given 17 beta-estradiol showed significantly greater (P<0.001) accumulation of lactate (80%) and H+ (79%). This was even shown in intact males, where despite a blunted response, 17 beta-estradiol, significantly (P<0.05) increased lactate by 39% and H+ by 25%. CONCLUSION This study illustrates the mechanisms for the sex difference in the liver's metabolic response to ischemia are estrogen mediated, which is seen even in the presence of male hormones, thus offering one explanation for the lower liver transplant success when the donor is female.
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Affiliation(s)
- Stjepan Soric
- Department of Physiology, Medical Sciences Building, University of Toronto, Toronto, Canada
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