%A Serrano,M. Trinidad %A Sabroso,Sergio %A Esteban,Luis M. %A Berenguer,Marina %A Fondevila,Constantino %A Lorente,Sara %A Cortés,Luis %A Sanchez-Antolin,Gloria %A Nuño,Javier %A De la Rosa,Gloria %A Salcedo,Magdalena %D 2022 %J Transplant International %C %F %G English %K liver transplantation,Mortality,survival,sex differences,cause of death %Q %R 10.3389/ti.2022.10263 %W %L %M %P %7 %8 2022-May-09 %9 Original Research %# %! SEX-DIFFERENCES IN LIVER TRANSPLANT MORTALITY %* %< %T Mortality and Causes of Death After Liver Transplantation: Analysis of Sex Differences in a Large Nationwide Cohort %U https://www.frontierspartnerships.org/articles/10.3389/ti.2022.10263 %V 35 %0 JOURNAL ARTICLE %@ 1432-2277 %X In the last few years, several studies have analyzed sex and gender differences in liver transplantation (LT), but none have performed a disaggregated analysis of both mortality and causes of death. Data from 15,998 patients, 11,914 (74.5%) males and 4,069 (25.5%) females, transplanted between 2000 and 2016 were obtained from the Liver Transplantation Spanish Registry. Survival analysis was applied to explore recipient sex as a risk factor for death. The causes of death at different follow-up duration were disaggregated by recipient sex for analysis. Short-term survival was higher in males, whereas long-term survival was higher in females. Survival at 1, 5 and 10 years post-transplant was 87.43%, 73.83%, and 61.23%, respectively, in males and 86.28%, 74.19%, and 65.10%, respectively, in females (p = 0.05). Post-LT mortality related to previous liver disease also presented sex differences. Males had 37% increased overall mortality from acute liver failure (p = 0.035) and 37% from HCV-negative cirrhosis (p < 0.001). Females had approximately 16% increased mortality when the liver disease was HCV-positive cirrhosis (p = 0.003). Regarding causes of death, non-malignancy HCV+ recurrence (6.3% vs. 3.9% of patients; p < 0.001), was more frequently reported in females. By contrast, death because of malignancy recurrence (3.9% vs. 2.2% of patients; p = 0.003) and de novo malignancy (4.8% vs. 2.5% of patients; p < 0.001) were significantly more frequent in male recipients. Cardiovascular disease, renal failure, and surgical complications were similar in both. In summary, male patients have lower short-term mortality than females but higher long-term and overall mortality. In addition, the post-LT mortality risk related to previous liver disease and the causes of mortality differ between males and females.