Sex Disparities in Outcomes Following Major Liver Surgery: New Powers of Estrogen?

Aim: To explore potential sex differences in outcomes and regenerative parameters post major hepatectomies. Background: Although controversial, sex differences in liver regeneration have been reported for animals. Whether sex disparity exists in human liver regeneration is unknown. Methods: Data from consecutive hepatectomy patients (55 females, 67 males) and from the international ALPPS (Associating-Liver-Partition-and-Portal-vein-ligation-for-Staged-hepatectomy, a two stage hepatectomy) registry (449 females, 729 males) were analyzed. Endpoints were severe morbidity (≥3b Clavien-Dindo grades), Model for End-stage Liver Disease (MELD) scores, and ALPPS interstage intervals. For validation and mechanistic insight, female-male ALPSS mouse models were established. t, χ2, or Mann-Whitney tests were used for comparisons. Univariate/multivariate analyses were performed with sensitivity inclusion. Results: Following major hepatectomy (Hx), males had more severe complications (P=0.03) and higher liver dysfunction (MELD) P=0.0001) than females. Multivariate analysis established male sex as a predictor of complications after ALPPS stage 1 (odds ratio=1.78; 95% confidence interval: 1.126–2.89; P=0.01), and of enhanced liver dysfunction after stage 2 (odds ratio=1.93; 95% confidence interval: 1.01–3.69; P=0.045). Female patients displayed shorter interstage intervals (
Source: Annals of Surgery - Category: Surgery Tags: ESA Paper Source Type: research