Differences in excess mortality by recipient sex after liver transplant

Identification of sex differences in mortality may prompt sex-specific management strategies. Males worldwide have higher mortality than females; therefore, we compared sex differences in excess mortality. We compared excess mortality in female versus male first liver transplant recipients, accounting for modifying effects of donor sex and recipient current age using relative survival models. Models were fitted separately in Scientific Registry of Transplant Recipients and CTS cohorts (1988-2019) and subsequently combined using two-stage individual patient data meta-analysis. We analyzed 218,429 patients. Within the first 3 months post-transplant, female recipients ≥25 years showed significantly higher excess mortality regardless of donor sex and female recipients 13-24 years had significantly higher excess mortality when the donor was male. Subsequent to the first 3 months, female recipients 0-12 years had significantly lower excess mortality regardless of donor sex; female recipients ≥25 years had lower excess mortality, though only significantly among those 25-44 years with a female donor. Females ≥25 years showed higher excess mortality than males in the immediate post-transplant period but, among those who survived, the first 3 months, excess mortality was similar by sex or lower in females than males. After the first 3 months post-transplant, female recipients 0-12 years showed lower excess mortality.