Racial and Ethnic Differences in Graft Loss Among Female Liver Transplant Recipients

Abstract

Younger AA women are at particularly high risk for graft loss, which predominates in the first 2 years post-LT. Prospective studies of immunosuppression adherence and pharmacokinetics, particularly in relation to patient age, may help to explain the mechanisms underlying the higher rates of graft loss in younger AA women.

The fundamentals of sex‐based disparity in liver transplantation: Understanding can lead to change

“…[ 56 ] In one study, younger African‐American women were at a higher risk of graft loss especially in the first 2 years after LT (45% higher in women <40 years [ p = 0.002]) compared with older populations. [ 57 ] This group postulated that younger women may have differing immunosuppressive needs as a common cause of graft loss was chronic rejection. They suggested intensified monitoring of tacrolimus levels to ensure therapeutic targets and if this was not possible, then using alternate regimens.…”

“…They suggested intensified monitoring of tacrolimus levels to ensure therapeutic targets and if this was not possible, then using alternate regimens. [57] The etiology of liver disease may also contribute as African Americans with acute liver failure tend to have autoimmune hepatitis as a causative etiology, [58] which can recur aggressively and lead to poor outcomes including graft loss. It remains controversial whether female sex affects long-term posttransplantation survival.…”

“…Renal dysfunction [46] Yes Female sex is an independent risk factor for stage 3 or higher CKD at 5 years after LT OR 2.96 CVD [50] No No studies have shown sex-based differences Malignancy [52] Unknown Following LT, men aged >50 years are at a greater risk of developing hematological, skin, male reproductive, and throat malignancies -Following LT, females are at a higher risk of developing gynecological, breast, and lung cancer Graft failure and death [21,57,59,60] Unknown Women undergoing LT had lower rates of graft failure and death…”