AASLD: Survival Lower in HCV-Infected Women after Liver Transplant

AASLD: Survival Lower in HCV-Infected Women after Liver Transplant
By John Gever, Senior Editor, MedPage Today
Published: November 02, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
for reading medical news
BOSTON -- Women undergoing liver transplant as a result of hepatitis C virus (HCV) infection show poorer long-term survival rates and more frequent failure of the donor liver, compared with male recipients, a researcher said here.

Female gender was associated with a hazard ratio for five-year mortality of 1.46 (95% CI 1.04 to 2.03) in multivariate analysis of 195 female and 655 male liver recipients, reported Jennifer Lai, MD, of the University of California San Francisco.

Women were also at almost 40% higher risk for overall graft loss (HR 1.39, 95% CI 1.39 to 1.89), Lai said here at the annual meeting of the American Association for the Study of Liver Disease.
Action Points

* Explain to interested patients that the study suggested that HCV-infected women may have worse outcomes than men after liver transplantation, but the reasons were unknown.


* Explain that there are few alternatives to transplantation for patients with advanced liver disease related to HCV infection.


* Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.

"Further studies are needed to evaluate modifiable donor factors and post-transplant therapies that influence [women's] outcomes," she told attendees at a plenary presentation.

She said previous studies were equivocal on whether gender affects survival and graft loss rates in HCV-infected liver transplant recipients.

Moreover, the earlier research included patients whose transplants occurred before the current system for allocating donor livers, based on Model for End-Stage Liver Disease (MELD) scores, was instituted earlier in the decade.

The study conducted by Lai and her colleagues included all adult liver transplant recipients with HCV-related liver disease at a network of four major centers from March 2002 to December 2007.

A co-diagnosis of hepatocellular carcinoma was not an exclusion, but patients with HIV or who were negative for HCV RNA after transplant were excluded, as were those whose grafts failed within a month of transplant.

Overall, with median follow-up of 3.1 years, 22% of transplant recipients had died and 25% had sustained graft loss.

Graft loss with recurrent HCV infection occurred in 10% of patients. Advanced recurrent disease was seen in 26%.

Lai said that women were at substantially increased risk for these latter outcomes -- a 44% increased chance of advanced recurrent HCV and 84% higher rates of graft loss associated with recurrent infection.

In addition to female gender, factors significantly associated with outcomes included:

* African-American race: HR for mortality 1.66 (95% CI 1.09 to 2.55); HR for graft loss 1.51 (95% CI 1.00 to 2.26)
* Post-transplant antiviral treatment: HR for mortality 0.57 (95% CI 0.40 to 0.80); HR for graft loss 0.70 (95% CI 0.51 to 0.95)
* Donor age, per year: HR for mortality 1.03 (95% CI 1.02 to 1.04); HR for graft loss 1.02 (95% CI 1.01 to 1.03)

Lai emphasized that these factors were adjusted for in the hazard ratios calculated for female gender.

She suggested several potential explanations for the higher risks that women appeared to run:

* Differential effects of aging in women compared with men
* Gender mismatch between donors and recipients -- these were more common with female versus male recipients in the study
* Renal impairment prior to transplant, also more likely to occur with women than men in the sample

Gregory Everson, MD, a hepatologist at the University of Colorado in Denver, who was not involved in the study, said he was not entirely surprised by the findings.

He said one of the first studies to examine the role of gender in liver transplant outcomes had also found a disadvantage for women. "This kind of confirms the finding," Everson said.

He added that, at this point, there wasn't a clear clinical implication. Everson agreed with Lai that more research is needed to identify the factors underlying the gender differences and how they might be alleviated either prior to or after transplantation.

The study was supported by the National Institutes of Health.

Lai had no potential conflicts of interest. Other co-authors reported relationships with Salix, Gilead, GlaxoSmithKline, Novartis, Schering, Vertex, Roche, Siemens, Schering-Plough, SciClone, and Human Genome Sciences.

Everson reported relationships with Schering-Plough and Ortho Biotech.

Primary source: Hepatology
Source reference:
Lai J, et al "Hepatitis C virus (HCV) infected females are at higher risk of graft loss after liver transplantation (LT): A multicenter cohort study" Hepatology 2009; 50: S304A-305A.