Hepatitis c virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men

Jennifer C. Lai, Elizabeth C. Verna, Robert S. Brown, Jacqueline G. O'Leary, James F. Trotter, Lisa M. Forman, Jeffrey D. Duman, Richard G. Foster, R. Todd Stravitz, Norah A. Terrault

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

In natural history studies of hepatitis C virus (HCV) infection, women have a lower risk of disease progression to cirrhosis. Whether female sex influences outcomes of HCV in the posttransplantation setting is unknown. All patients transplanted for HCV-related liver disease from 2002-2007 at five United States transplantation centers were included. The primary outcome was development of advanced disease, defined as biopsy-proven bridging fibrosis or cirrhosis. Secondary outcomes included death, graft loss, and graft loss with advanced recurrent disease. A total of 1,264 patients were followed for a median of 3 years (interquartile range, 1.8-4.7), 304 (24%) of whom were women. The cumulative rate of advanced disease at 3 years was 38% for women and 33% for men (P = 0.31), but after adjustment for recipient age, donor age, donor anti-HCV positivity, posttransplantation HCV treatment, cytomegalovirus infection and center, female sex was an independent predictor of advanced recurrent disease (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.02-1.70; P = 0.04). Among women, older donor age and treated acute rejection were the primary predictors of advanced disease. The unadjusted cumulative 3-year rates of patient and graft survival were numerically lower in women (75% and 74%, respectively) than men (80% and 78%, respectively), and in multivariable analyses, female sex was an independent predictor for death (HR, 1.30; 95% CI, 1.01-1.67; P = 0.04) and graft loss (HR, 1.31; 95% CI, 1.02-1.67; P = 0.03). Conclusion: Female sex represents an underrecognized risk factor for advanced recurrent HCV disease and graft loss. Further studies are needed to determine whether modification of donor factors, immunosuppression, and posttransplantation therapeutics can equalize HCV-specific outcomes in women and men.

Original languageEnglish (US)
Pages (from-to)418-424
Number of pages7
JournalHepatology
Volume54
Issue number2
DOIs
StatePublished - Aug 1 2011

Fingerprint

Hepatitis Viruses
Hepacivirus
Liver Transplantation
Fibrosis
Transplants
Tissue Donors
Virus Diseases
Confidence Intervals
Cytomegalovirus Infections
Graft Survival
Natural History
Immunosuppression
Disease Progression
Liver Diseases
Transplantation
Biopsy
Therapeutics

ASJC Scopus subject areas

  • Hepatology

Cite this

Hepatitis c virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men. / Lai, Jennifer C.; Verna, Elizabeth C.; Brown, Robert S.; O'Leary, Jacqueline G.; Trotter, James F.; Forman, Lisa M.; Duman, Jeffrey D.; Foster, Richard G.; Stravitz, R. Todd; Terrault, Norah A.

In: Hepatology, Vol. 54, No. 2, 01.08.2011, p. 418-424.

Research output: Contribution to journalArticle

Lai, JC, Verna, EC, Brown, RS, O'Leary, JG, Trotter, JF, Forman, LM, Duman, JD, Foster, RG, Stravitz, RT & Terrault, NA 2011, 'Hepatitis c virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men', Hepatology, vol. 54, no. 2, pp. 418-424. https://doi.org/10.1002/hep.24390
Lai, Jennifer C. ; Verna, Elizabeth C. ; Brown, Robert S. ; O'Leary, Jacqueline G. ; Trotter, James F. ; Forman, Lisa M. ; Duman, Jeffrey D. ; Foster, Richard G. ; Stravitz, R. Todd ; Terrault, Norah A. / Hepatitis c virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men. In: Hepatology. 2011 ; Vol. 54, No. 2. pp. 418-424.
@article{e09018bc2c4f4ba8827817e49c17c90b,
title = "Hepatitis c virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men",
abstract = "In natural history studies of hepatitis C virus (HCV) infection, women have a lower risk of disease progression to cirrhosis. Whether female sex influences outcomes of HCV in the posttransplantation setting is unknown. All patients transplanted for HCV-related liver disease from 2002-2007 at five United States transplantation centers were included. The primary outcome was development of advanced disease, defined as biopsy-proven bridging fibrosis or cirrhosis. Secondary outcomes included death, graft loss, and graft loss with advanced recurrent disease. A total of 1,264 patients were followed for a median of 3 years (interquartile range, 1.8-4.7), 304 (24{\%}) of whom were women. The cumulative rate of advanced disease at 3 years was 38{\%} for women and 33{\%} for men (P = 0.31), but after adjustment for recipient age, donor age, donor anti-HCV positivity, posttransplantation HCV treatment, cytomegalovirus infection and center, female sex was an independent predictor of advanced recurrent disease (hazard ratio [HR], 1.31; 95{\%} confidence interval [CI], 1.02-1.70; P = 0.04). Among women, older donor age and treated acute rejection were the primary predictors of advanced disease. The unadjusted cumulative 3-year rates of patient and graft survival were numerically lower in women (75{\%} and 74{\%}, respectively) than men (80{\%} and 78{\%}, respectively), and in multivariable analyses, female sex was an independent predictor for death (HR, 1.30; 95{\%} CI, 1.01-1.67; P = 0.04) and graft loss (HR, 1.31; 95{\%} CI, 1.02-1.67; P = 0.03). Conclusion: Female sex represents an underrecognized risk factor for advanced recurrent HCV disease and graft loss. Further studies are needed to determine whether modification of donor factors, immunosuppression, and posttransplantation therapeutics can equalize HCV-specific outcomes in women and men.",
author = "Lai, {Jennifer C.} and Verna, {Elizabeth C.} and Brown, {Robert S.} and O'Leary, {Jacqueline G.} and Trotter, {James F.} and Forman, {Lisa M.} and Duman, {Jeffrey D.} and Foster, {Richard G.} and Stravitz, {R. Todd} and Terrault, {Norah A.}",
year = "2011",
month = "8",
day = "1",
doi = "10.1002/hep.24390",
language = "English (US)",
volume = "54",
pages = "418--424",
journal = "Hepatology",
issn = "0270-9139",
publisher = "John Wiley and Sons Ltd",
number = "2",

}

TY - JOUR

T1 - Hepatitis c virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men

AU - Lai, Jennifer C.

AU - Verna, Elizabeth C.

AU - Brown, Robert S.

AU - O'Leary, Jacqueline G.

AU - Trotter, James F.

AU - Forman, Lisa M.

AU - Duman, Jeffrey D.

AU - Foster, Richard G.

AU - Stravitz, R. Todd

AU - Terrault, Norah A.

PY - 2011/8/1

Y1 - 2011/8/1

N2 - In natural history studies of hepatitis C virus (HCV) infection, women have a lower risk of disease progression to cirrhosis. Whether female sex influences outcomes of HCV in the posttransplantation setting is unknown. All patients transplanted for HCV-related liver disease from 2002-2007 at five United States transplantation centers were included. The primary outcome was development of advanced disease, defined as biopsy-proven bridging fibrosis or cirrhosis. Secondary outcomes included death, graft loss, and graft loss with advanced recurrent disease. A total of 1,264 patients were followed for a median of 3 years (interquartile range, 1.8-4.7), 304 (24%) of whom were women. The cumulative rate of advanced disease at 3 years was 38% for women and 33% for men (P = 0.31), but after adjustment for recipient age, donor age, donor anti-HCV positivity, posttransplantation HCV treatment, cytomegalovirus infection and center, female sex was an independent predictor of advanced recurrent disease (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.02-1.70; P = 0.04). Among women, older donor age and treated acute rejection were the primary predictors of advanced disease. The unadjusted cumulative 3-year rates of patient and graft survival were numerically lower in women (75% and 74%, respectively) than men (80% and 78%, respectively), and in multivariable analyses, female sex was an independent predictor for death (HR, 1.30; 95% CI, 1.01-1.67; P = 0.04) and graft loss (HR, 1.31; 95% CI, 1.02-1.67; P = 0.03). Conclusion: Female sex represents an underrecognized risk factor for advanced recurrent HCV disease and graft loss. Further studies are needed to determine whether modification of donor factors, immunosuppression, and posttransplantation therapeutics can equalize HCV-specific outcomes in women and men.

AB - In natural history studies of hepatitis C virus (HCV) infection, women have a lower risk of disease progression to cirrhosis. Whether female sex influences outcomes of HCV in the posttransplantation setting is unknown. All patients transplanted for HCV-related liver disease from 2002-2007 at five United States transplantation centers were included. The primary outcome was development of advanced disease, defined as biopsy-proven bridging fibrosis or cirrhosis. Secondary outcomes included death, graft loss, and graft loss with advanced recurrent disease. A total of 1,264 patients were followed for a median of 3 years (interquartile range, 1.8-4.7), 304 (24%) of whom were women. The cumulative rate of advanced disease at 3 years was 38% for women and 33% for men (P = 0.31), but after adjustment for recipient age, donor age, donor anti-HCV positivity, posttransplantation HCV treatment, cytomegalovirus infection and center, female sex was an independent predictor of advanced recurrent disease (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.02-1.70; P = 0.04). Among women, older donor age and treated acute rejection were the primary predictors of advanced disease. The unadjusted cumulative 3-year rates of patient and graft survival were numerically lower in women (75% and 74%, respectively) than men (80% and 78%, respectively), and in multivariable analyses, female sex was an independent predictor for death (HR, 1.30; 95% CI, 1.01-1.67; P = 0.04) and graft loss (HR, 1.31; 95% CI, 1.02-1.67; P = 0.03). Conclusion: Female sex represents an underrecognized risk factor for advanced recurrent HCV disease and graft loss. Further studies are needed to determine whether modification of donor factors, immunosuppression, and posttransplantation therapeutics can equalize HCV-specific outcomes in women and men.

UR - http://www.scopus.com/inward/record.url?scp=79960714300&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960714300&partnerID=8YFLogxK

U2 - 10.1002/hep.24390

DO - 10.1002/hep.24390

M3 - Article

C2 - 21538434

AN - SCOPUS:79960714300

VL - 54

SP - 418

EP - 424

JO - Hepatology

JF - Hepatology

SN - 0270-9139

IS - 2

ER -