目的:在各种肝脏疾病中观察到性别特异性差异,但是性别对肝移植(LT)后肝细胞癌(HCC)预后的影响仍有待确定。这项研究是中国首次在全国范围内对性别在HCC患者LT后结局中的作用进行调查。
方法:分析了2015年1月至2020年12月在中国肝移植注册中心注册的HCC受者的数据。捐赠者之间的联系,收件人,或按性别划分的供体-受体移植模式和LT后结局采用倾向评分匹配(PSM)进行研究.进一步研究了与不同性别的供体-受体移植模式相关的存活率。
结果:在这项研究的3,769名患者中,1-,3-,肝移植后HCC患者的5年总生存率(OS)为96.1%,86.4%,78.5%,分别,在女性接受者中,和95.8%,79.0%,70.7%,分别,在PSM后的男性接受者中(P=0.009)。然而,有女性供者和男性供者的受者之间的OS具有可比性.多因素分析显示,男性受者性别是肝移植术后生存的危险因素(HR=1.381,P=0.046)。在供体-受体移植模式中,男性-男性供者-受者移植模式与移植后存活最差相关(P<0.05).
结论:我们的研究结果强调,女性接受者的LT后结局明显优于男性接受者,男性-男性供者-受者移植模式与LT术后生存最差相关.来自男性捐赠者的肝脏可能为女性接受者提供最大的益处。我们的结果表明,性别应被视为器官分配的关键因素。
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.