This review is the report of the 3rd International Meeting of Women in Hepatology, Formigine, Italy, June 29-30, 2012.
Influence of Age and Gender Before and After Liver Transplantation
Article first published online: 12 FEB 2013
Copyright © 2012 American Association for the Study of Liver Diseases
Volume 19, Issue 2, pages 122–134, February 2013
How to Cite
Burra, P., Martin, E. D., Gitto, S. and Villa, E. (2013), Influence of Age and Gender Before and After Liver Transplantation. Liver Transpl, 19: 122–134. doi: 10.1002/lt.23574
These authors contributed equally to this work.
- Issue published online: 12 FEB 2013
- Article first published online: 12 FEB 2013
- Accepted manuscript online: 21 NOV 2012 02:54PM EST
- Manuscript Accepted: 8 NOV 2012
- Manuscript Received: 24 JUL 2012
Women constitute a particular group among patients with chronic liver disease and in the post–liver transplantation (LT) setting: they are set apart not only by traditional differences with respect to men (ie, body mass index, different etiologies of liver disease, and accessibility to transplantation) but also by factors related to hormonal changes that characterize first the fertile age and subsequently the postmenopausal period (eg, disease course variability and responses to therapy). The aim of this review is, therefore, to evaluate the role of the interplay of factors such as age, gender, and hormones in influencing the natural history of chronic liver disease before and after LT and their importance in determining outcomes after LT. As the population requiring LT ages and the mean age at transplantation increases, older females are being considered for transplantation. Older patients are at greater risk for nonalcoholic steatohepatitis, osteoporosis, and a worse response to antiviral therapy. Female gender per se is associated with a greater risk for osteoporosis because of metabolic changes after menopause, the bodily structure of females, and, in the population of patients with chronic liver disease, the prevalence of cholestatic and autoimmune liver diseases. With menopause, the fall of protective estrogen levels can lead to increased fibrosis progression, and this represents a negative turning point for women with chronic liver disease and especially for patients with hepatitis C. Therefore, the notion of gender as a binary female/male factor is now giving way to the awareness of more complex disease processes within the female gender that follow hormonal, social, and age patterns and need to be addressed directly and specifically. Liver Transpl 19:122–134, 2013. © 2012 AASLD.