Gender Disparities in Patients With Alcoholic Liver Disease Evaluated for Liver Transplantation.
Gender Disparities in Patients With Alcoholic Liver Disease Evaluated for Liver Transplantation.
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评估肝移植的酒精性肝病患者的性别差异。
DOI：
10.1097/tp.0000000000002843
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发表时间：
2020-02
期刊：
影响因子：
6.2
通讯作者：
Mellinger J
中科院分区：
文献类型：
--
作者：
McElroy LM;Likhitsup A;Scott Winder G;Saeed N;Hassan A;Sonnenday CJ;Fontana RJ;Mellinger J
在美国，酒精相关性肝病（ALD）的发病率和死亡率正在增加。然而，关于ALD患者肝移植（LT）评估和列表的性别差异知之甚少。这是对2010年1月1日至2017年3月1日在单个移植中心接受LT评价的ALD成人患者的回顾性审查。进行单变量、多变量和时间序列分析。在评估的949例ALD患者中，平均年龄为53岁，84%为白人，33%为女性。终末期肝病评分的中位模型在两种性别之间相似。女性患者不太可能被列为LT患者（10%对19%; P < 0.05）。由于使用活性物质而未列出的女性比例显著高于男性（42%比35%; P < 0.05），而医疗禁忌症的频率在性别之间相当。在平均416天的随访期间（范围：0-2784），ALD患者接受移植的可能性较低（42%对47%; P < 0.05）。与ALD女性相比，ALD男性被列入名单的可能性高95%，移植的可能性高105%。虽然男性有更多的终身物质使用和相关后果，但女性有更多的精神病合并症，并且由于活跃的酒精和阿片类药物使用而不太可能被列出。早期发现和有效治疗ALD妇女的精神和物质使用障碍可能会提高其移植资格。
The morbidity and mortality from alcohol-related liver disease (ALD) is increasing in the United States. However, little is known about gender differences in evaluation and listing for liver transplantation (LT) in patients with ALD. This is a retrospective review of adult patients with ALD evaluated for LT at a single transplant center from January 1, 2010, to March 1, 2017. Univariate, multivariate, and time-series analyses were performed. Among the 949 patients with ALD evaluated, mean age was 53 years, 84% were Caucasian, and 33% were women. The median model for end-stage liver disease score was similar between the genders. Women were less likely to be listed for LT (10% versus 19%; P < 0.05). The proportion of women not listed due to active substance use was significantly higher versus men (42% versus 35%; P < 0.05), while the frequency of medical contraindications was comparable between the genders. During a median follow-up of 416 days (range: 0–2784), listed women with ALD were less likely to undergo transplantation (42% versus 47%; P < 0.05). Men with ALD were 95% more likely to be listed and 105% more likely to be transplanted compared to women with ALD. While men had more lifetime substance use and related consequences, women had more psychiatric comorbidities and were less likely to be listed due to active alcohol and opioid use. Early detection and effective treatment of psychiatric and substance use disorders in women with ALD may improve their transplant eligibility.