Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2011 Aug;54(2):418-24.
doi: 10.1002/hep.24390. Epub 2011 Jun 23.

Hepatitis C virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men

Jennifer C Lai  1 , Elizabeth C Verna, Robert S Brown Jr, Jacqueline G O'Leary, James F Trotter, Lisa M Forman, Jeffrey D Duman, Richard G Foster, R Todd Stravitz, Norah A Terrault; Consortium to Study Health Outcomes in HCV Liver Transplant Recipients (CRUSH-C)
Affiliations
Comparative Study

Hepatitis C virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men

Jennifer C Lai et al. Hepatology. 2011 Aug.

Abstract

In natural history studies of hepatitis C virus (HCV) infection, women have a lower risk of disease progression to cirrhosis. Whether female sex influences outcomes of HCV in the posttransplantation setting is unknown. All patients transplanted for HCV-related liver disease from 2002-2007 at five United States transplantation 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. A total of 1,264 patients were followed for a median of 3 years (interquartile range, 1.8-4.7), 304 (24%) of whom were women. The cumulative rate of advanced disease at 3 years was 38% for women and 33% for men (P=0.31), but after adjustment for recipient age, donor age, donor anti-HCV positivity, posttransplantation HCV treatment, cytomegalovirus infection and center, female sex was an independent predictor of advanced recurrent disease (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.02-1.70; P=0.04). 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 women (75% and 74%, respectively) than men (80% and 78%, respectively), and in multivariable analyses, female sex was an independent predictor for death (HR, 1.30; 95% CI, 1.01-1.67; P=0.04) and graft loss (HR, 1.31; 95% CI, 1.02-1.67; P=0.03).

Conclusion: Female sex represents an underrecognized risk factor for advanced recurrent HCV disease and graft loss. Further studies are needed to determine whether modification of donor factors, immunosuppression, and posttransplantation therapeutics can equalize HCV-specific outcomes in women and men.

PubMed Disclaimer

Conflict of interest statement

Disclosures: No conflicts of interest exist.

Figures

Figure 1
Figure 1
Adjusted Rates of Advanced Fibrosis By Gender in HCV-infected Liver Transplant Recipients.
Figure 2
Figure 2
Adjusted Rates of Graft Survival by Gender in HCV-infected Liver Transplant Recipients
See this image and copyright information in PMC

References

    1. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet. 1997 Mar 22;349(9055):825–32. - PubMed
    1. Thomas DL, Astemborski J, Rai RM, Anania FA, Schaeffer M, Galai N, et al. The natural history of hepatitis C virus infection: host, viral, and environmental factors. JAMA. 2000 Jul 26;284(4):450–6. - PubMed
    1. Yasuda M, Shimizu I, Shiba M, Ito S. Suppressive effects of estradiol on dimethylnitrosamine-induced fibrosis of the liver in rats. Hepatology. 1999 Mar;29(3):719–27. - PubMed
    1. Yuan Y, Shimizu I, Shen M, Aoyagi E, Takenaka H, Itagaki T, et al. Effects of estradiol and progesterone on the proinflammatory cytokine production by mononuclear cells from patients with chronic hepatitis C. World J Gastroenterol. 2008 Apr 14;14(14):2200–7. - PMC - PubMed
    1. Velidedeoglu E, Mange KC, Frank A, Abt P, Desai NM, Markmann JW, et al. Factors differentially correlated with the outcome of liver transplantation in hcv+ and HCV- recipients. Transplantation. 2004 Jun 27;77(12):1834–42. - PubMed

Publication types