Superior Post-Transplant Outcomes for Female Liver Recipients Compared to Males - EMJ

Superior Post-Transplant Outcomes for Female Liver Recipients Compared to Males

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FEMALES demonstrate superior survival rates than males following liver transplantation (LT), according to a recent study. The study in question, a multicentre cohort study, examined how the sex of both donors and recipients influences survival rates after LT.

The study analysed data from the China Liver Transplant Registry, encompassing 3,769 patients who underwent LT between January 2015–December 2020. Researchers used propensity score matching to explore the relationships between donor sex, recipient sex, and the outcomes of various sex-based donor-recipient transplant patterns.

The findings demonstrated that female recipients of LT had significantly better survival rates compared to their male counterparts. Specifically, the 1-, 3-, and 5-year overall survival (OS) rates for female recipients were 96.1%, 86.4%, and 78.5%, respectively. In contrast, male recipients had OS rates of 95.8%, 79.0%, and 70.7%, respectively, after propensity score matching (p=0.009).

Notably, the OS rates were comparable between recipients of female and male donor livers, indicating that the recipient’s sex plays a more crucial role in post-transplant outcomes than the donor’s sex alone. Multivariate analysis identified male recipient sex as a risk factor for poorer post-LT survival, with a hazard ratio of 1.381 (P=0.046).

Of the various donor-recipient sex combinations, the male-male transplant pattern was associated with the poorest survival outcomes (P<0.05). This suggests that livers from male donors may offer the greatest benefit when transplanted into female recipients.

“The results underscore the importance of considering sex when evaluating post-transplant survival and making organ allocation decisions” commented Jian Chen, the study’s lead author. The superior outcomes for female recipients and the detrimental impact of the male-male transplant pattern highlight the need for tailored approaches in liver transplant procedures to optimise patient survival and outcomes.


Chen J et al. Influence of sex on outcomes of liver transplantation for hepatocellular carcinoma: a multicenter cohort study in China. Cancer Biol Med. 2024; 21(4):347-362.

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