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Hepatitis C virus infected females have a higher risk of advanced fibrosis and graft loss after liver transplantation than males

, : Hepatitis C virus infected females have a higher risk of advanced fibrosis and graft loss after liver transplantation than males.

In natural history studies of hepatitis C virus (HCV) infection, women have a lower risk of disease progression to cirrhosis. Whether gender influences outcomes of HCV in the post-transplant setting is unknown. All patients transplanted for HCV-related liver disease from 22-27 at 5 U.S. transplant centers were included. The primary outcome was development of advanced disease, defined as biopsy-proven bridging fibrosis or cirrhosis. Secondary outcomes included death, graft loss, and graft loss with advanced recurrent disease. 1,264 patients were followed for a median of 3. years (IQR 1.8-4.7) 34 (24%) were female. The cumulative rate of advanced disease at 3-years was 38% for females and 33% for males (p=.31) but after adjustment for recipient age, donor age, donor anti-HCV positivity, post-transplant HCV treatment, cytomegalovirus infection and center, female gender was an independent predictor of advanced recurrent disease (HR, 1.31; 95%CI, 1.2-1.7; p=.4). Among women, older donor age and treated acute rejection were the primary predictors of advanced disease. The unadjusted cumulative 3 year rates of patient and graft survival were numerically lower in females than males, 75% vs. 8% and 74% vs. 78%, and in multivariable analyses, female gender was an independent predictor for death (HR, 1.3; 95%CI, 1.1-1.67; p=.4) and graft loss (HR, 1.31; 95%CI, 1.2-1.67; p=.3).Female gender represents an under-recognized risk factor for advanced recurrent HCV disease and graft loss. Further studies are needed to determine whether modification of donor factors, immunosuppression, and post-transplant therapeutics can equalize HCV-specific outcomes in women and men.


DOI: 10.1002/hep.24390

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