Impact of donor sex on hepatocellular carcinoma recurrence in liver transplantation after brain death

Tsukasa Nakamura; Kazunari Sasaki; Lisa Kojima; Richard Teo; Yosuke Inaba; Takayuki Yamamoto; Shoko Kimura; Leigh Anne Dageforde; Heidi Yeh; Nahel Elias; Adel Bozorgzadeh; Tatsuo Kawai; James F Markmann

doi:10.1111/ctr.14989

Impact of donor sex on hepatocellular carcinoma recurrence in liver transplantation after brain death

Clin Transplant. 2023 Aug;37(8):e14989. doi: 10.1111/ctr.14989. Epub 2023 Apr 11.

Affiliations

¹ Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
² Division of Abdominal Transplantation, Stanford University, Stanford, California, USA.
³ Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
⁴ Biostatistics Section, Chiba University Hospital Clinical Research Center, Chiba, Japan.

PMID: 37039506
DOI: 10.1111/ctr.14989

Abstract

Background: Hepatocellular carcinoma (HCC) is predominantly seen in males but has a better prognosis in females. No prior studies have investigated HCC recurrence based on sex combination following liver transplant donated after brain death (DBDLT). This study sought to elucidate the effects of donor and recipient sex on HCC recurrence rates.

Methods: 9232 adult recipients from the United Network for Organ Sharing (UNOS) database who underwent DBDLT for HCC from 2012 to 2018 were included. Donor-recipient pairs were divided into (1) female donor/female recipient (F-F) (n = 1089); (2) male donor/female recipient (M-F) (n = 975); (3) female donor/male recipient (F-M) (n = 2691); (4) male donor/male recipient (M-M) (n = 4477). The primary prognostic outcome was HCC recurrence. A multivariable competing risk regression analysis was used to assess prognostic influences.

Results: The median recipient age and model for end-stage liver disease (MELD) scores were similar among the four groups. Livers of male recipients demonstrated greater in size and number of HCC (both p-values were <.0001). There was also a higher rate of vascular invasion in male recipients compared to female (p < .0001). Competing risk analyses showed that the cumulative HCC recurrence rate was significantly lower in the M-F group (p = .013). After adjusting for tumor characteristics, liver grafts from male donors were associated with a lower HCC recurrence rate in female recipients (HR: .62 95%CI: .42-.93) (p = .021).

Conclusion: In DBDLT, male donor to female recipient pairing exhibited lower HCC recurrence rates.

Summary: Lowest rates of HCC recurrence were confirmed among the female recipients of male donor grafts group in the deceased donor LT cohort. A competing risk multivariable regression analysis demonstrated that male donor sex was significantly associated with low HCC recurrence in female but not male recipients.

Keywords: donation after brain death; hepatocellular carcinoma; liver transplant; recurrence; sex.

MeSH terms

Adult
Brain Death
Carcinoma, Hepatocellular* / pathology
Carcinoma, Hepatocellular* / surgery
End Stage Liver Disease*
Female
Humans
Liver Neoplasms* / pathology
Liver Neoplasms* / surgery
Liver Transplantation*
Male
Neoplasm Recurrence, Local
Retrospective Studies
Risk Factors
Severity of Illness Index