title: Recipient female gender is a risk factor for graft loss after liver transplantation for chronic hepatitis C: Evidence from the prospective Liver Match cohort.
abstract: BACKGROUND
  Female gender has been reported to be a risk factor for graft loss after liver transplantation for hepatitis C virus (HCV)-related cirrhosis but evidence is limited to retrospective studies.
  
  
  OBJECTIVE
  To investigate the impact of recipient gender and donor/recipient gender mismatch on graft outcome.
  
  
  METHODS
  We performed a survival analysis of a cohort of 1530 first adult transplants enrolled consecutively in Italy between 2007 and 2009 and followed prospectively. After excluding possible confounding factors (fulminant hepatitis, human immunodeficiency virus co-infection, non-viremic anti-HCV positive subjects), a total of 1394 transplant recipients (604 HCV-positive and 790 HCV-negative) were included.
  
  
  RESULTS
  Five-year graft survival was significantly reduced in HCV-positive patients (64% vs 76%, p=0.0002); Cox analysis identified recipient female gender (HR=1.44, 95% CI 1.03-2.00, p=0.0319), Mayo clinic End stage Liver Disease score (every 10 units, HR=1.25, 95% CI 1.03-1.50; p=0.022), portal thrombosis (HR=2.40, 95% CI 1.20-4.79, p=0.0134) and donor age (every 10 years, HR=1.14, 95% CI 1.05-1.24, p=0.0024) as independent determinants of graft loss. All additional mortality observed among female recipients was attributable to severe HCV recurrence.
  
  
  CONCLUSIONS
  This study unequivocally shows that recipient female gender unfavourably affects the outcome of HCV-infected liver grafts.
authors.affiliation: Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy. Electronic address: luca.belli@ospedaleniguarda.it.
authors.forename: Luca Saverio
authors.initials: LS
authors.lastname: Belli
authors.affiliation: Liver Transplant Center, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Romagnoli
authors.affiliation: Department of Mathematics, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Nardi
authors.affiliation: Department of Mathematics, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Tania
authors.initials: T
authors.lastname: Marianelli
authors.affiliation: Division of Digestive Diseases, "Maggiore" University Hospital, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Donato
authors.affiliation: Division of Gastroenterology, Sapienza University, Rome, Italy.
authors.forename: Stefano Ginanni
authors.initials: SG
authors.lastname: Corradini
authors.affiliation: Liver Transplant Center, University Hospital, Modena, Italy.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Iemmolo
authors.affiliation: Liver Transplant Center, University Hospital, Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Morelli
authors.affiliation: Gastroenterology and Transplant Hepatology, San Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Pasulo
authors.affiliation: Department of Emergency and Organ Transplantation, University Hospital, Bari, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Rendina
authors.affiliation: Liver Transplant Center, University Hospital, Padua, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: De Martin
authors.affiliation: Department of Internal Medicine and Gastroenterology, Gemelli Hospital, Rome, Italy.
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Ponziani
authors.affiliation: Mediterranean Institute for Transplant, Palermo, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Volpes
authors.affiliation: Digestive Disease Section, University Hospital Milano Bicocca and Yale University Center, New Haven, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Strazzabosco
authors.affiliation: Hepatology Unit, Tor Vergata University, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Angelico
mesh_terms: D000367:Age Factors; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D013927:Thrombosis / Q000150:complications*
chemical_list: D012367:RNA, Viral
keywords: Donor age; Graft loss; HCV; HCV recurrence; Liver transplantation; Recipient gender