Recipient female gender is a risk factor for graft loss after liver transplantation for chronic hepatitis C: Evidence from the prospective Liver Match cohort

Background: Female gender has been reported to be a risk factor for graft loss after liver transplantation for hepatitis C virus (HCV)-related cirrhosis but evidence is limited to retrospective studies. Aims: To investigate the impact of recipient gender and donor/recipient gender mismatch on graft outcome. Methods: We performed a survival analysis of a cohort of 1530 first adult transplants enrolled consecutively in Italy between 2007 and 2009 and followed prospectively. After excluding possible confounding factors (fulminant hepatitis, human immunodeficiency virus co-infection, non-viremic anti-HCV positive subjects), a total of 1394 transplant recipients (604 HCV-positive and 790 HCV-negative) were included. Results: Five-year graft survival was significantly reduced in HCV-positive patients (64% vs 76%, p = 0.0002); Cox analysis identified recipientfemale gender (HR = 1.44, 95% CI 1.03–2.00, p = 0.0319), Mayo clinic End stage Liver Disease score (every 10 units, HR = 1.25, 95% CI 1.03–1.50; p = 0.022), portal thrombosis (HR = 2.40, 95% CI 1.20–4.79, p = 0.0134) and donor age (every 10 years, HR = 1.14, 95% CI 1.05–1.24, p = 0.0024) as independent determinants of graft loss. All additional mortality observed among female recipients was attributable to severe HCV recurrence. Conclusions. This study unequivocally shows that recipient female gender unfavourably affects the outcome of HCV-infected liver grafts