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Cancer Biology & Medicine 2024, 21(4): 347-362 https://doi.org/10.20892/j.issn.2095-3941.2023.0453
Original Article | Open Access | Issue | Published: 28 February 2024

Influence of sex on outcomes of liver transplantation for hepatocellular carcinoma: a multicenter cohort study in China

Show Author's Information Jian Chen1,*,  Zhe Yang2,3,*,  Fengqiang Gao1,  Zhisheng Zhou4,  Junli Chen4,  Di Lu1,  Kai Wang1,  Meihua Sui1,  Zhengxin Wang5,  Wenzhi Guo6,  Guoyue Lyu7,  Haizhi Qi8,  Jinzhen Cai9,  Jiayin Yang10,  Shusen Zheng2,3,11,12 ( ),  Xiao Xu1,2,4,11 ( )
Zhejiang University School of Medicine, Hangzhou 310030, China
Institute of Organ Transplantation, Zhejiang University, Hangzhou 310030, China
Department of Hepatobiliary and Pancreatic Surgery, Shulan Hospital of Hangzhou, Hangzhou 310006, China
National Center for Healthcare Quality Management in Liver Transplant, Hangzhou 310003, China
Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, China
Department of Liver Transplantation, Second Xiangya Hospital, Central South University, Changsha 410008, China
Department of Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610044, China
NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China

*These authors contributed equally to this work.

Keywords:
donor, hepatocellular carcinoma, Sex, liver transplantation, recipient, outcome
Cite this article:
Chen J, Yang Z, Gao F, et al. Influence of sex on outcomes of liver transplantation for hepatocellular carcinoma: a multicenter cohort study in China. Cancer Biology & Medicine, 2024, 21(4): 347-362. https://doi.org/10.20892/j.issn.2095-3941.2023.0453
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Abstract Full text About this article
Objective

Sex-specific differences are observed in various liver diseases, but the influence of sex on the outcomes of hepatocellular carcinoma (HCC) after liver transplantation (LT) remains to be determined. This study is the first Chinese nationwide investigation of the role of sex in post-LT outcomes in patients with HCC.

Methods

Data for recipients with HCC registered in the China Liver Transplant Registry between January 2015 and December 2020 were analyzed. The associations between donor, recipient, or donor-recipient transplant patterns by sex and the post-LT outcomes were studied with propensity score matching (PSM). The survival associated with different sex-based donor-recipient transplant patterns was further studied.

Results

Among 3,769 patients enrolled in this study, the 1-, 3-, and 5-year overall survival (OS) rates of patients with HCC after LT were 96.1%, 86.4%, and 78.5%, respectively, in female recipients, and 95.8%, 79.0%, and 70.7%, respectively, in male recipients after PSM (P = 0.009). However, the OS was comparable between recipients with female donors and male donors. Multivariate analysis indicated that male recipient sex was a risk factor for post-LT survival (HR = 1.381, P = 0.046). Among the donor-recipient transplant patterns, the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival (P < 0.05).

Conclusions

Our findings highlighted that the post-LT outcomes of female recipients were significantly superior to those of male recipients, and the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival. Livers from male donors may provide the most benefit to female recipients. Our results indicate that sex should be considered as a critical factor in organ allocation.


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Abstract
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About this article

Influence of sex on outcomes of liver transplantation for hepatocellular carcinoma: a multicenter cohort study in China

Show Author's information Jian Chen1,*, Zhe Yang2,3,*, Fengqiang Gao1, Zhisheng Zhou4, Junli Chen4, Di Lu1, Kai Wang1, Meihua Sui1, Zhengxin Wang5, Wenzhi Guo6, Guoyue Lyu7, Haizhi Qi8, Jinzhen Cai9, Jiayin Yang10, Shusen Zheng2,3,11,12 ( ), Xiao Xu1,2,4,11 ( )
Zhejiang University School of Medicine, Hangzhou 310030, China
Institute of Organ Transplantation, Zhejiang University, Hangzhou 310030, China
Department of Hepatobiliary and Pancreatic Surgery, Shulan Hospital of Hangzhou, Hangzhou 310006, China
National Center for Healthcare Quality Management in Liver Transplant, Hangzhou 310003, China
Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, China
Department of Liver Transplantation, Second Xiangya Hospital, Central South University, Changsha 410008, China
Department of Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610044, China
NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China

*These authors contributed equally to this work.

Abstract

Objective

Sex-specific differences are observed in various liver diseases, but the influence of sex on the outcomes of hepatocellular carcinoma (HCC) after liver transplantation (LT) remains to be determined. This study is the first Chinese nationwide investigation of the role of sex in post-LT outcomes in patients with HCC.

Methods

Data for recipients with HCC registered in the China Liver Transplant Registry between January 2015 and December 2020 were analyzed. The associations between donor, recipient, or donor-recipient transplant patterns by sex and the post-LT outcomes were studied with propensity score matching (PSM). The survival associated with different sex-based donor-recipient transplant patterns was further studied.

Results

Among 3,769 patients enrolled in this study, the 1-, 3-, and 5-year overall survival (OS) rates of patients with HCC after LT were 96.1%, 86.4%, and 78.5%, respectively, in female recipients, and 95.8%, 79.0%, and 70.7%, respectively, in male recipients after PSM (P = 0.009). However, the OS was comparable between recipients with female donors and male donors. Multivariate analysis indicated that male recipient sex was a risk factor for post-LT survival (HR = 1.381, P = 0.046). Among the donor-recipient transplant patterns, the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival (P < 0.05).

Conclusions

Our findings highlighted that the post-LT outcomes of female recipients were significantly superior to those of male recipients, and the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival. Livers from male donors may provide the most benefit to female recipients. Our results indicate that sex should be considered as a critical factor in organ allocation.

Keywords: donor, hepatocellular carcinoma, Sex, liver transplantation, recipient, outcome

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Publication history
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Publication history

Received: 05 December 2023
Accepted: 25 January 2024
Published: 28 February 2024
Issue date: April 2024

Copyright

©2024 The Authors.

Acknowledgements

The authors thank the China Liver Transplant Registry and the National Center for Healthcare Quality Management in Liver Transplant for accepting the request to conduct this study.

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Creative Commons Attribution-NonCommercial 4.0 International License

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