Sex-based Disparities in Liver Transplantation for Hepatocellular Carcinoma and the Impact of the Growing Burden of NASH
Year: 2024
Type: article
Study design: Observational Study
Abstract: Background. The cause of liver disease is changing, but its impact on liver transplantation (LT) for hepatocellular carcinoma (HCC) in women and men is unclear. We performed a nationwide study to assess the prevalence and posttransplant survival outcomes of the various causes of liver disease in women and men with HCC. Methods. Data were obtained from the United Network for Organ Sharing database from 2000 to 2022. Data related to the listing, transplant, waitlist mortality, and posttransplant mortality for HCC were extracted. The proportion of HCC related to the various causes of liver disease among LT candidates and recipients and posttransplant survival were compared between women and men. Results. A total of 51 721 individuals (39 465 men, 12 256 women) with HCC were included. From 2000 to 2022, nonalcoholic steatohepatitis (NASH) was the fastest-growing cause of liver disease among female LT candidates with HCC (P < 0.01), followed by alcohol-associated liver disease. NASH overtook chronic hepatitis C as the leading cause of liver disease in 2020 and 2022 among waitlisted women and men with HCC, respectively. Female patients with HCC spent a significantly longer time on the LT waitlist compared with male patients (β: 8.73; 95% confidence interval [CI], 2.91-14.54). Female patients with HCC from alcohol-associated liver disease also have a lower probability of receiving LT (subdistribution hazard ratio: 0.90; 95% CI, 0.82-0.99). Among transplant recipients with NASH HCC, female sex was associated with lower posttransplant mortality compared with male sex (hazard ratio: 0.79; 95% CI, 0.70-0.89; P < 0.01). Conclusions. Women have a significantly longer waitlist duration compared with men. NASH is now the leading cause of liver disease among both female and male LT candidates and recipients with HCC.
Source: Transplantation Direct
Authors: Jia Hong Koh, Douglas Chee, Cheng Han Ng, Karn Wijarnpreecha, Mark Muthiah, Darren Jun Hao Tan, Wen Hui Lim, Rebecca Wenling Zeng, Benjamin Koh, Eunice Tan Xiang Xuan, Glenn Bonney, Shridhar Iyer, Dan Yock Young, Toru Nakamura, Hirokazu Takahashi, Mazen Noureddin, Mohammad Shadab Siddiqui, Tracey G. Simon, Rohit Loomba, Daniel Q. Huang
Institutions: National University Hospital, University of Arizona College of Medicine- Phoenix, National University of Singapore, Kurume University, Saga University, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, Massachusetts General Hospital, University of California San Diego, National University Health System
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,200
Awards: A Cardiovascular-NASH disease nexus: Common Mechanisms and Treatments?, DETECTION AND MODELS OF TOXICANT EXPOSURE, Non-invasive screening of diabetics for advanced fibrosis due to NAFLD, Ancillary Studies of NAFLD and NASH in HIV infected Adults, QUS Technology for Diagnosis and Grading of Hepatic Steatosis in NAFLD, UC San Diego Clinical and Translational Research Institute, San Diego Digestive Diseases Research Center, Clinical Research on Nonalcoholic Fatty Liver Disease, San Diego Cirrhosis Clinical Research Network
OpenAlex ID: W4399901774