It is known that women waiting for a liver transplant in the US are about a third more likely than men to get too sick to undergo surgery or to die before receiving a liver. A study conducted by UC San Francisco and Columbia University shows the role frailty plays in this gender gap.
The study tracked 1,405 cirrhotic patients, 41 percent of whom were women awaiting a liver transplant at nine transplant centers in the United States. The men, whose ages were between 49 and 63 years, were more likely to have chronic hepatitis C and alcoholic liver disease (27 percent versus 22 and 33 percent versus 19 percent). The women, aged between 50 and 63, were more likely to have nonalcoholic fatty liver disease and autoimmune cholestatic liver disease (23 percent versus 16 percent and 23 percent versus 9 percent).
The researchers, led by lead author Jennifer Lai, MD, MBA, a general and transplant hepatologist at the UCSF Department of Medicine, found that both sexes had similar severity of liver disease, but fewer women had high blood pressure and coronary artery disease . Even so, they were significantly more frail, according to tests with the Liver Frailty Index (LFI), which showed weaker gender-adjusted grip, poorer balance, and slower standing up from a sitting position.
"This is the first time that frailty has been identified and quantified as a risk factor in women with cirrhosis waiting for liver transplants," Lai said. "The significance of this finding is that this gender gap can potentially be narrowed through early interventions as basic as providing adequate calorie and protein intake and regular exercise. Doctors can advise women on diet and strength interventions, build strength. " These steps can be helpful for women undergoing another organ transplant, as frailty can also play a role there, the authors say.
While the causes of frailty have not been investigated, Lai said it was generally due to physical inactivity, chronic liver failure, and poor diet.
Over the course of the study, the women had a 36 percent higher risk of waiting list mortality, which was defined as death or delisting because they were too sick to have a transplant. After adjusting for LFI scores and other variables, the researchers concluded that frailty accounts for 13 percent of the gender gap in waiting list mortality. While the study does not address the other factors that offset gender inequality, the authors note differences in kidney function and the higher percentage of male donors who may be poorly suited to women due to their smaller stature.
The greatest importance of the study, Lai said, is at the population level of liver transplant patients in the United States.
"The gender waiting-list mortality gap has existed across the US liver transplant system for 15 years and will continue to exist if not detected," she said. Fortunately, "now that it has been recognized, it can be addressed."
Frailty related to waiting list mortality in liver transplants in cirrhosis of the liver
University of California, San Francisco
Frailty is a factor in higher mortality among women awaiting liver transplantation (2020, December 30th).
accessed on December 30, 2020
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