Influence of sex on outcomes of liver transplantation for hepatocellular carcinoma: a multicenter cohort study in China

Abstract

Objective: Sex-specific differences are observed in various liver diseases, but the influence of sex on the outcomes of hepatocellular carcinoma (HCC) after liver transplantation (LT) remains to be determined. This study is the first Chinese nationwide investigation of the role of sex in post-LT outcomes in patients with HCC.

Methods: Data for recipients with HCC registered in the China Liver Transplant Registry between January 2015 and December 2020 were analyzed. The associations between donor, recipient, or donor-recipient transplant patterns by sex and the post-LT outcomes were studied with propensity score matching (PSM). The survival associated with different sex-based donor-recipient transplant patterns was further studied.

Results: Among 3,769 patients enrolled in this study, the 1-, 3-, and 5-year overall survival (OS) rates of patients with HCC after LT were 96.1%, 86.4%, and 78.5%, respectively, in female recipients, and 95.8%, 79.0%, and 70.7%, respectively, in male recipients after PSM (P = 0.009). However, the OS was comparable between recipients with female donors and male donors. Multivariate analysis indicated that male recipient sex was a risk factor for post-LT survival (HR = 1.381, P = 0.046). Among the donor-recipient transplant patterns, the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival (P < 0.05).

Conclusions: Our findings highlighted that the post-LT outcomes of female recipients were significantly superior to those of male recipients, and the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival. Livers from male donors may provide the most benefit to female recipients. Our results indicate that sex should be considered as a critical factor in organ allocation.

Keywords: Sex; donor; hepatocellular carcinoma; liver transplantation; outcome; recipient.

Figure 1

Flowchart of the study.

Figure 2

Overall survival (OS) and disease-free survival (DFS) of male recipients and female recipients after PSM. (A) OS of male recipients and female recipients. (B) DFS of male recipients and female recipients. M-R, male recipients; F-R, female recipients.

Figure 3

Overall survival (OS) and disease-free survival (DFS) of recipients with male donors and female donors after PSM. (A) OS of recipients with male donors and female donors. (B) DFS of recipients with male donors and female donors. M-D, male donors; F-D, female donors.

Figure 4

Overall survival (OS) of different donor-recipient match patterns based on sex after PSM. OS of different transplant patterns based on sex. M-M, male donor transplant to male recipient; F-F, female donor transplant to female recipient; M-F, male donor transplant to female recipient; F-M, female donor transplant to male recipient.