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

Dig Liver Dis. 2015 Aug;47(8):689-94. doi: 10.1016/j.dld.2015.04.006. Epub 2015 Apr 16.


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 recipient female 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.

Keywords: Donor age; Graft loss; HCV; HCV recurrence; Liver transplantation; Recipient gender.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • End Stage Liver Disease / surgery*
  • Female
  • Graft Survival*
  • Hepacivirus / genetics
  • Hepatitis C, Chronic / surgery*
  • Humans
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Portal Vein*
  • Proportional Hazards Models
  • Prospective Studies
  • RNA, Viral / blood
  • Recurrence
  • Risk Factors
  • Severity of Illness Index
  • Sex Factors*
  • Survival Rate
  • Thrombosis / complications*


  • RNA, Viral