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Influence of Age and Gender Before and After Liver Transplantation

Authors

  • Patrizia Burra,

    Corresponding author
    • Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
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    • This review is the report of the 3rd International Meeting of Women in Hepatology, Formigine, Italy, June 29-30, 2012.

  • Eleonora De Martin,

    1. Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
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  • Stefano Gitto,

    1. Department of Gastroenterology, University Teaching Hospital/University of Modena and Reggio Emilia, Modena, Italy
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  • Erica Villa

    Corresponding author
    • Department of Gastroenterology, University Teaching Hospital/University of Modena and Reggio Emilia, Modena, Italy
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    • This review is the report of the 3rd International Meeting of Women in Hepatology, Formigine, Italy, June 29-30, 2012.


  • These authors contributed equally to this work.

Address reprint requests to Patrizia Burra, M.D., Ph.D., Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Via Giustiniani 2, 35128 PD, Padua, Italy. Telephone: +39.049.8218726; FAX: +39.049.8218727; E-mail: burra@unipd.it; or Erica Villa, M.D., Department of Gastroenterology, University Teaching Hospital/University of Modena and Reggio Emilia, Via del Pozzo 1, 41124, Modena, Italy. Telephone: +39.059.4225308; FAX: +39.059.4224363; E-mail: erica.villa@unimore.it

Abstract

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.

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