Relevance of Male-to-Female Sex Mismatch in Liver Transplantation for Primary Biliary Cirrhosis
Relevance of Male-to-Female Sex Mismatch in Liver Transplantation for Primary Biliary Cirrhosis
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DOI：
10.12659/aot.892394
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发表时间：
2015-03-02
影响因子：
1.1
通讯作者：
Krawczyk, Marek
中科院分区：
文献类型：
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作者：
Grat, Michal;Lewandowski, Zbigniew;Krawczyk, Marek
背景：由于男性到女性的移植与暴露于H-Y抗原有关，性别匹配可能会影响自身免疫性疾病肝移植后的预后。这项回顾性研究的目的是评估原发性胆汁性肝硬变(PBC)肝移植中男女配型不匹配的相关性。材料/方法：这项回顾性研究基于同一机构82例女性PBC肝移植患者的数据。主要的结果衡量标准是移植物10年的存活率。结果：女性对女性和男性对女性的移植后移植物存活率相似(10年时分别为74.7%和73.1%，P=0.676)。至于其他危险因素的不同影响，长时间的冷缺血和输血量增加对男性到女性移植后的预后产生不利影响(p=0.039和p=0.039)，但在女性到女性移植后(p=0.843和p=0.110)。在输血4单位和冷缺血8小时的患者中，性别不匹配的移植患者的10年移植物存活率较低(61.4%比100.0%，p=0.063)。结论：尽管性别不匹配似乎不会对肝移植后的预后产生直接的负面影响，但它会加剧长期冷缺血和输血的负面影响。
Background: Because male-to-female transplantations are related to exposure to H-Y antigen, sex matching may influence the outcomes after liver transplantation for autoimmune diseases. The purpose of this retrospective study was to evaluate the relevance of male-to-female mismatch in liver transplantation for primary biliary cirrhosis (PBC).Material/Methods: This retrospective study was based on the data of 82 female liver transplant recipients with PBC from a single institution. The primary outcome measure was graft survival at 10 years. The negative effects of well-known risk factors for poor outcomes were evaluated separately and compared between the female-to-female and male-to-female transplantations.Results: Graft survival was similar after female-to-female and male-to-female transplantations (74.7% versus 73.1% at 10 years, respectively, p=0.676). Regarding the differential impact of other risk factors, prolonged cold ischemia and increased amount of blood transfusions adversely influenced outcomes after male-to-female transplantation (p=0.039 and p=0.039, respectively) but not after female-to-female transplantation (p=0.843 and p=0.110, respectively). Sex mismatched transplantations were associated with lower 10-year graft survival in subgroups of patients with blood transfusions >4 units (61.4% versus 100.0%, p=0.063) and >8 hours of cold ischemia (54.7% versus 75.8%, p=0.418).Conclusions: Although male-to-female sex mismatch does not seem to yield a direct negative impact on outcomes following liver transplantation for PBC, it can aggravate the negative effects of prolonged cold ischemia and blood transfusions.