肝细胞癌患者接受肝移植的性别和体型差异。

IF 15.7 1区 医学 Q1 SURGERY
David C Cron, Rafal D Mazur, Irun Bhan, Joel T Adler, Heidi Yeh
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引用次数: 0

摘要

重要性:在肝移植候选名单中,女性接受移植的可能性低于男性。最近解决这一差异的方法包括调整终末期肝病模型(MELD)评分,但这不会影响那些依靠异常评分而非计算MELD评分的候选者,而这些候选者中大多数患有肝细胞癌(HCC):目的:评估女性性别、候选者体型与肝细胞癌候选者接受肝移植之间的关系:这项回顾性队列研究使用的是美国移植登记处的数据,对象是2010年1月1日至2023年3月2日期间接受HCC异常评分的所有成人(年龄≥18岁)候选肝移植患者:采用多变量竞争风险回归法估算了女性性别与(1)已故供体肝移植(DDLT)和(2)死亡或因健康状况恶化而退出候选名单的关系。比较了调整和不调整候选者身高和体重(性别差异的媒介)的结果:该队列包括 31 725 名 HCC 候选人(接受例外治疗时的平均年龄为 61.2 [7.1] 岁;76.3% 为男性)。与男性相比,女性的 DDLT 1 年累积发病率较低(50.8% vs 54.0%;P 结论及意义:在这项研究中,与男性 HCC 患者相比,女性 HCC 患者接受 DDLT 的几率更低,在候选名单中死亡的几率更高;这些差异在很大程度上(但不完全)是由候选者规模的性别差异造成的。对于被列入异常评分的候选者,需要对分配政策进行额外的修改,以解决性别差异问题,包括改善较小候选者获得大小匹配的捐献肝脏的解决方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sex and Size Disparities in Access to Liver Transplant for Patients With Hepatocellular Carcinoma.

Importance: Women on the liver transplant waiting list are less likely to undergo a transplant than men. Recent approaches to resolving this disparity have involved adjustments to Model for End-Stage Liver Disease (MELD) scoring, but this will not affect candidates who rely on exception scores rather than calculated MELD score, the majority of whom have hepatocellular carcinoma (HCC).

Objective: To evaluate the association between female sex, candidate size, and access to liver transplant among wait-listed patients with HCC.

Design, setting, and participants: This retrospective cohort study used US transplant registry data of all adult (aged ≥18 years) wait-listed liver transplant candidates receiving an HCC exception score between January 1, 2010, and March 2, 2023.

Exposure: Wait-listed liver transplant candidate sex.

Main outcomes and measures: The association of female sex with (1) deceased-donor liver transplant (DDLT) and (2) death or waiting list removal for health deterioration were estimated using multivariable competing-risks regression. Results with and without adjustment for candidate height and weight (mediators of the sex disparity) were compared.

Results: The cohort included 31 725 candidates with HCC (mean [SD] age at receipt of exception, 61.2 [7.1] years; 76.3% men). Compared with men, women had a lower 1-year cumulative incidence of DDLT (50.8% vs 54.0%; P < .001) and a higher 1-year cumulative incidence of death or delisting for health deterioration (16.2% vs 15.0%; P = .002). After adjustment, without accounting for size, women had a lower incidence of DDLT (subdistribution hazard ratio [SHR], 0.92; 95% CI, 0.89-0.95) and higher incidence of death or delisting (SHR, 1.06; 95% CI, 1.00-1.13) compared with men. When adjusting for candidate height and weight, there was no association of female sex with incidence of DDLT or death or delisting. However, at a height cutoff of 166 cm, short women compared with short men were still less likely to undergo a transplant (SHR, 0.93; 95% CI, 0.88-0.99).

Conclusions and relevance: In this study, women with HCC were less likely to receive a DDLT and more likely to die while wait-listed than men with HCC; these differences were largely (but not entirely) explained by sex-based differences in candidate size. For candidates listed with exception scores, additional changes to allocation policy are needed to resolve the sex disparity, including solutions to improve access to size-matched donor livers for smaller candidates.

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来源期刊
JAMA surgery
JAMA surgery SURGERY-
CiteScore
20.80
自引率
3.60%
发文量
400
期刊介绍: JAMA Surgery, an international peer-reviewed journal established in 1920, is the official publication of the Association of VA Surgeons, the Pacific Coast Surgical Association, and the Surgical Outcomes Club.It is a proud member of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications.
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