Hepatitis C virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men.
Hepatitis C virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men.
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肝炎病毒感染的妇女的肝脏移植后晚期纤维化和移植物损失的风险高于男性。
DOI：
10.1002/hep.24390
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发表时间：
2011-08
期刊：
影响因子：
13.5
通讯作者：
Terrault, Norah A.
中科院分区：
文献类型：
--
作者：
Lai, Jennifer C.;Verna, Elizabeth C.;Brown, Robert S., Jr.;O'Leary, Jacqueline G.;Trotter, James F.;Forman, Lisa M.;Duman, Jeffrey D.;Foster, Richard G.;Stravitz, R. Todd;Terrault, Norah A.
在丙型肝炎病毒（HCV）感染的自然史研究中，女性疾病进展为肝硬化的风险较低。性别是否影响移植后HCV的结果尚不清楚。纳入了2002-2007年在5个美国移植中心因HCV相关肝病接受移植的所有患者。主要结局是晚期疾病的发展，定义为活检证实的桥接纤维化或肝硬化。次要结局包括死亡、移植物丢失和移植物丢失伴晚期复发性疾病。1，264例患者接受了中位3.0年（IQR 1.8-4.7）的随访，其中304例（24%）为女性。3年时晚期疾病的累积发生率女性为38%，男性为33%（p=0.31），但在对受体年龄、供体年龄、供体抗HCV阳性、移植后HCV治疗、巨细胞病毒感染和中心进行调整后，女性是晚期复发疾病的独立预测因素（HR，1.31; 95%CI，1.02-1.70; p=0.04）。在女性中，年龄较大的供体和治疗的急性排斥反应是晚期疾病的主要预测因素。女性患者和移植物未校正的3年累积存活率在数值上低于男性，分别为75%和80%，74%和78%，在多变量分析中，女性是死亡的独立预测因素（HR，1.30; 95%CI，1.01-1.67; p=0.04）和移植物丢失（HR，1.31; 95%CI，1.02-1.67; p=0.03）。女性是晚期复发性HCV疾病和移植物失功的一个未被充分认识的危险因素。需要进一步的研究来确定供体因素、免疫抑制和移植后治疗的改变是否可以使女性和男性的HCV特异性结果相等。
In natural history studies of hepatitis C virus (HCV) infection, women have a lower risk of disease progression to cirrhosis. Whether gender influences outcomes of HCV in the post-transplant setting is unknown. All patients transplanted for HCV-related liver disease from 2002–2007 at 5 U.S. transplant centers were included. The primary outcome was development of advanced disease, defined as biopsy-proven bridging fibrosis or cirrhosis. Secondary outcomes included death, graft loss, and graft loss with advanced recurrent disease. 1,264 patients were followed for a median of 3.0 years (IQR 1.8–4.7) −304 (24%) were female. The cumulative rate of advanced disease at 3-years was 38% for females and 33% for males (p=0.31) but after adjustment for recipient age, donor age, donor anti-HCV positivity, post-transplant HCV treatment, cytomegalovirus infection and center, female gender was an independent predictor of advanced recurrent disease (HR, 1.31; 95%CI, 1.02–1.70; p=0.04). Among women, older donor age and treated acute rejection were the primary predictors of advanced disease. The unadjusted cumulative 3–year rates of patient and graft survival were numerically lower in females than males, 75% vs. 80% and 74% vs. 78%, and in multivariable analyses, female gender was an independent predictor for death (HR, 1.30; 95%CI, 1.01–1.67; p=0.04) and graft loss (HR, 1.31; 95%CI, 1.02–1.67; p=0.03). Female gender represents an under-recognized risk factor for advanced recurrent HCV disease and graft loss. Further studies are needed to determine whether modification of donor factors, immunosuppression, and post-transplant therapeutics can equalize HCV-specific outcomes in women and men.
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影响因子：
8.8
作者：
Thuluvath, P. J.;Guidinger, M. K.;Pelletier, S. J.
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Pelletier, S. J.
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Trepo, C
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