Female gender in the setting of liver transplantation.
Female gender in the setting of liver transplantation.
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DOI：
10.5500/wjt.v4.i4.229
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发表时间：
2014-12-24
期刊：
影响因子：
--
通讯作者：
Burra, Patrizia
中科院分区：
文献类型：
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作者：
Rodriguez-Castro, Kryssia Isabel;De Martin, Eleonora;Burra, Patrizia
从肝病到终末期肝病或急性肝功能衰竭的演变、肝移植的评估过程、器官分配决策以及移植后的结果在性别上是不同的。终末期肝病模型(MELD)评分的使用阻碍了女性接受肝移植的机会，在MELD评分中，即使在存在不同程度的肾功能障碍的情况下，肌酐值也对女性施加了系统性的偏见，因为她们的值较低。此外，即使在对符合性别的肌酐测定的MELD评分进行校正时，移植的机会也普遍存在可量化的不平等，这表明还涉及其他因素。虽然一些差异可以从流行病学的角度来解释，但荷尔蒙状况起着重要作用。此外，绝经前和绝经后阶段意味着女性生理上的深刻差异，不仅包括从生育年龄到非生育阶段，而且还包括雌激素的丧失及其在延缓肝纤维化进展方面的潜在保护作用等。随着更年期，体重增加的趋势可能会导致先前存在的代谢综合征的发展或恶化。随着越来越多的患者接受非酒精性脂肪性肝炎的移植，以及移植时平均年龄的增加，临床医生必须为这种特殊情况的处理做好准备，特别是在绝经后的妇女，她们在绝经后有发生代谢并发症的特别风险。
The evolution of liver diseases to end-stage liver disease or to acute hepatic failure, the evaluation process for liver transplantation, the organ allocation decision-making, as well as the post-transplant outcomes are different between female and male genders. Women's access to liver transplantation is hampered by the use of model for end-stage liver disease (MELD) score, in which creatinine values exert a systematic bias against women due to their lower values even in the presence of variable degrees of renal dysfunction. Furthermore, even when correcting MELD score for gender-appropriate creatinine determination, a quantifiable uneven access to transplant prevails, demonstrating that other factors are also involved. While some of the differences can be explained from the epidemiological point of view, hormonal status plays an important role. Moreover, the pre-menopausal and post-menopausal stages imply profound differences in a woman's physiology, including not only the passage from the fertile age to the non-fertile stage, but also the loss of estrogens and their potentially protective role in delaying liver fibrosis progression, amongst others. With menopause, the tendency to gain weight may contribute to the development of or worsening of pre-existing metabolic syndrome. As an increasing number of patients are transplanted for non-alcoholic steatohepatitis, and as the average age at transplant increases, clinicians must be prepared for the management of this particular condition, especially in post-menopausal women, who are at particular risk of developing metabolic complications after menopause.