背景:性别差异与生物学差异有关,这可能对患者和同种异体移植结果有重大影响。目的是调查性别对实体器官移植(SOT)后临床和安全性结果的影响。
方法:进行系统评价和荟萃分析。比较女性与女性的观察性研究在对Pubmed进行系统搜索后,考虑将SOT后的男性纳入其中,科克伦图书馆,和2016年至2021年进行的WebofScience数据库。主要结果是死亡率。PROSPERO寄存器号:CRD42021282615。
结果:检索1103项研究后,22项观察性研究(1,045,380名受试者)最终被认为符合纳入条件。女性占SOT接受者的36.3%,但死亡率显著降低(比值比(OR):0.87,95%置信区间(CI):0.83~0.92,I2=78%).在亚组分析中,接受肝脏移植(OR:0.8995CI:0.86-0.92,I2=0%)或肾移植(OR:0.8295CI:0.76-0.89,I2=72%)的女性死亡率显著较低.男性一直被报道为防止再次入院的保护因素。在结果中,同种异体移植功能障碍受供体-受体性别和年龄共同影响.总体感染数据尚无定论。一些报告表明男性患恶性肿瘤的风险更高。
结论:女性占SOT受者的三分之一,但肝和肾移植后的存活率高于男性。对移植物功能障碍的影响是异质的。虽然需要进一步的研究,我们的研究结果应鼓励临床医生和研究人员在做出有关SOT管理的决定时考虑性别因素.
Sex disparities are related to biological differences, which may have significant impact on patient and allograft outcomes. The aim was to investigate the impact of sex on clinical and safety outcomes after solid organ transplantation (SOT).
A systematic review and meta-analysis was performed. Observational studies comparing females vs. males after SOT were considered for inclusion after a systematic search of the Pubmed, Cochrane Library, and Web of Science databases conducted from 2016 to 2021. Primary outcome was mortality. PROSPERO register number: CRD42021282615.
After retrieving 1103 studies, 22 observational studies (1,045,380 subjects) were finally deemed eligible for inclusion. Females accounted 36.3% of SOT recipients, but presented significantly lower mortality (odds ratio (OR): 0.87, 95% confidence interval (CI): 0.83-0.92, I2=78%). In subgroup analyses, mortality was significantly lower in females undergoing liver (OR: 0.89 95%CI: 0.86-0.92, I2=0%) or kidney transplantation (OR: 0.82 95%CI: 0.76-0.89, I2=72%). Male sex was consistently reported as a protective factor against hospital readmission. Among the outcomes, allograft dysfunction was influenced by a combination of donor-recipient sex and age. Data on overall infections were inconclusive. Several reports suggest a higher risk of malignancy among males.
Females represent one-third of SOT recipients but have higher survival rates than males after liver and kidney transplantation. The impact on graft dysfunction was heterogeneous. While further research is warranted, our findings should encourage clinicians and researchers to consider sex as a factor when taking decisions regarding SOT management.