Impact of recipient sex on long-term survival after liver transplantation in patients with high MELD
Recommended Citation
Aceituno L, Magyar C, Li Z, Claasen M, Ivanics T, Winter E, Bucur R, Rukavina N, Choi W, Selzner N, Bhat M, Lilly L, Tsien C, Patel K, Selzner M, Mcgilvray I, Reichman T, Shwaartz C, Ghanekar A, Cattral MS, Sayed B, Jaeckel E, Sapisochin G. Impact of recipient sex on long-term survival after liver transplantation in patients with high MELD. J Hepatol 2024; 80:S381.
Document Type
Conference Proceeding
Publication Date
6-1-2024
Publication Title
J Hepatol
Abstract
Background and aims: The MELD score is used to prioritize liver transplant (LT) candidates for deceased donor organs, with a “sickest first” approach. However, it has been shown that MELD score does not accurately reflect disease severity in females. It remains controversial whether recipient sex affects long-term post-transplantation survival. This study aimed to assess the impact of sex in a high MELD cohort on (1) long-term survival post-LT, (2) and its association with underlying diseases, cause of transplant, and comorbidities. Method: Retrospective cohort study at Toronto General Hospital, including adult LT recipients with a MELD ≥25 at transplant between January 2007 and December 2019. Patients were stratified by sex. Survival analysis was performed using a priori multivariable Cox regression and Kaplan-Meier analysis. A post hoc sex-stratified multivariable Cox regression model was performed. Results: 478 patients with MELD ≥25 were included; 196 (40%) were females, with a median BMI of 27.4 kg/m2 (IQR 23.7–31.2). The median follow-up post-LT was 5.7 years (IQR 2.2, 9.2) with a median waitlist of 23.5 days (IRQ 0.0, 75.5). The median listing and pretransplant MELD scores were 28 (IQR 21–34), and 31 (IQR 26–35) respectively. Male recipients had pre-transplant higher rates of ascites (39.8% vs. 53.5%; p = 0.003) and hepatic encephalopathy (34.2% vs. 44.3%; p = 0.026). Autoimmune hepatitis as underlying disease was more prevalent among females (26.5% vs. 12.4%; p < 0.005). Conversely, viral hepatitis (8.7% vs. 24.8%; p < 0.001), alcoholrelated cirrhosis (ALD) (13.3% vs. 28.7%; p < 0.001), and mixed ALD + viral cirrhosis (1.0% vs. 5.0%; p = 0.018) were more frequent in males. Females were more frequently transplanted for acute liver failure (16.8% vs. 4.6%; p < 0.001) and fewer for cancer (4.6% vs. 11.3%; p = 0.009). No statistically significant differenceswere observed between sex crude overall long-term survival (log-rank p = 0.681), or estimated effect (HR 0.92; p = 0.686). In the a priori multivariable analysis, sex was not significant (HR 0.94, CI 95% 0.61–1.43; p = 0.779).There were no sex differences in early post-transplant mortality (<90 days) (6.6% females vs. 9.2% males; p = 0.309; HR 0.71, p = 0.329), mortality in the 1st year (10.7% females vs. 14.5% males; p = 0.221), 5th (16.8% females vs. 18.8% males; p = 0.584) and 10th year (20.4% females vs. 22.0% males; p = 0.679). There was no difference in risk of postoperative complications. On post hoc multivariable analysis stratified by sex, re-transplantation (HR 2.80; CI 95% 1.53–5.14; p = 0.001) and ICU stay (HR 1.009; CI 95% 1.005– 1.01; p < 0.001) were significant risk factors for female mortality. Conclusion: Our findings show no sex differences in the overall survival in high MELD liver transplant recipients. Female patients with longer ICU admission, or requiring re-transplantation, were at higher risk of all-cause mortality.
Volume
80
First Page
S381
