基于性别的肝移植差异：来自意大利全国队列的证据

IF 9.5 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

JHEP Reports Pub Date : 2025-03-07 DOI:10.1016/j.jhepr.2025.101387

Chiara Becchetti , Silvia Trapani , Lucia Masiero , Silvia Testa , Francesca D’Arcangelo , Lucia Lapenna , Manuela Merli , Valentina Cossiga , Maria Guarino , Filomena Morisco , Marta Cilla , Federica Invernizzi , Elisabetta Cerutti , Pierluigi Toniutto , Francesca Puoti , Massimo Cardillo , Giuseppe Feltrin , Patrizia Burra , Special Interest Group (SIG) Gender in Hepatology of the Associazione Italiana Studio del Fegato (AISF)

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引用次数: 0

摘要

背景,目的尽管肝移植（LT）中基于性别的差异已经被承认了好几年，特别是在美国进行的研究，但来自欧洲国家的数据很少。方法：我们对2017年1月至2021年12月在意大利确定的LT候选人进行了一项全国性、回顾性、观察性研究，使用国家登记数据，随访至2023年6月。主要目的是评估肝移植通路的性别差异，分析摘取、再移植和死亡率。患者从等待名单入院到移植、切除或死亡进行监测，并进行竞争风险建模（Fine和Gray）多变量分析。使用Kaplan-Meier估计、时间相关Cox模型和分层log-rank检验评估生存结果。结果共纳入7563例患者，其中男性5575例，占73.7%。在肝硬化（亚分布风险比[sHR] 1.13, 95% CI 1.02-1.26, p = 0.02, sHR 1.12, 95% CI 1.01-1.24, p = 0.03）和肝细胞癌（HCC）（sHR 1.20, 95% CI 1.07-1.36, p = 0.003, sHR 1.21, 95% CI 1.08-1.35, p = 0.001）中，男性1年和2年接受肝移植的概率均高于女性。除了肝移植指征为HCC（10.6%对14.2%,p = 0.035）外，男性的等待名单（WL）退出率与女性没有显著差异（12.6%对13.9%,p = 0.14）。此外，男性的等候名单（WL）死亡率低于女性（7.0%对8.5%,p = 0.04）。两种性别的术后生存率相似。结论：在这个庞大的意大利队列中，女性标准分配患者与男性相比似乎处于劣势，因为她们接受肝移植的频率较低，但肝移植后的结果相似。影响和意义尽管多年来，尤其是在美国进行的研究中，人们已经认识到基于性别的肝移植差异，但欧洲的数据很少。我们的研究详尽地概述了美国以外的妇女在获得lt方面面临的劣势。通过详细说明这些差异，它为制定公平的卫生政策提供了坚实的论据。鉴于这些差异受到国家情况的影响，拥有当地数据对于确定可能的目标行动至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Sex-based disparities in liver transplantation: Evidence from a nationwide Italian cohort

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Sex-based disparities in liver transplantation: Evidence from a nationwide Italian cohort

Background & Aims

Although sex-based disparities in the liver transplantation (LT) setting have been acknowledged for several years, particularly by studies conducted in the USA, data from European countries are scarce.

Methods

We conducted a nationwide, retrospective, observational study on candidates identified for LT in Italy between January 2017 and December 2021 using national registry data with follow-up until June 2023. The primary aim was to assess sex-based differences in LT access, analyzing delisting, retransplantation, and mortality rates. Patients were monitored from waitlist admission to transplant, removal, or death, with competing risks modeled (Fine and Gray) multivariable analysis. Survival outcomes were evaluated using Kaplan–Meier estimates, time-dependent Cox models, and stratified log-rank tests.

Results

In total, 7,563 patients were included in the analysis, 5,575 (73.7%) of whom were men. Men had higher 1- and 2-year probabilities of undergoing LT compared with women for both liver cirrhosis (subdistribution hazard ratio [sHR] 1.13, 95% CI 1.02–1.26, p = 0.02 and sHR 1.12, 95% CI 1.01–1.24, p = 0.03, respectively) and hepatocellular carcinoma (HCC) (sHR 1.20, 95% CI 1.07–1.36, p = 0.003 and sHR 1.21, 95% CI 1.08–1.35, p = 0.001, respectively). The wait list (WL) dropout rate in men did not differ significantly to that for women (12.6% vs. 13.9%, p = 0.14) except when the indication to LT was HCC (10.6% vs. 14.2%, p = 0.035). In addition, men had a lower wait list (WL) mortality rate compared with women (7.0% vs. 8.5%, p = 0.04). Post-LT survival rates were similar for both sexes.

Conclusions

In this large Italian cohort, female standard allocation patients appeared to be at a disadvantage compared with men, because they received LT less frequently, but with similar post-LT outcomes.

Impact and implications

Although sex-based disparities in the LT setting have been acknowledged for several years, particularly in studies conducted in the USA, few data are available in Europe. Our study provides an exhaustive overview regarding the disadvantage facing women outside the USA in accessing LT. By detailing these differences, it provides solid arguments for developing equitable health policy. Given that these differences are affected by the national scenario, having local data is crucial for defining possible targeted actions.

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来源期刊

JHEP Reports GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

12.40

自引率

2.40%

发文量

161

审稿时长

36 days

期刊介绍： JHEP Reports is an open access journal that is affiliated with the European Association for the Study of the Liver (EASL). It serves as a companion journal to the highly respected Journal of Hepatology. The primary objective of JHEP Reports is to publish original papers and reviews that contribute to the advancement of knowledge in the field of liver diseases. The journal covers a wide range of topics, including basic, translational, and clinical research. It also focuses on global issues in hepatology, with particular emphasis on areas such as clinical trials, novel diagnostics, precision medicine and therapeutics, cancer research, cellular and molecular studies, artificial intelligence, microbiome research, epidemiology, and cutting-edge technologies. In summary, JHEP Reports is dedicated to promoting scientific discoveries and innovations in liver diseases through the publication of high-quality research papers and reviews covering various aspects of hepatology.