Author ORCID Identifier
0009-0009-1400-4647
Date of Award
Winter 1-7-2025
Degree Type
Thesis
Degree Name
Master of Public Health (MPH)
Department
Public Health
First Advisor
Dr. Lisa Casanova
Second Advisor
Jessica Tarabay
Abstract
Alcoholic Liver Disease (ALD) leads to an estimated 30,910 deaths per year in the United States, for a mortality rate of 9.3/100,000 per year (CDC, 2024). Among patients who undergo liver transplant, recipients of livers from female donors tend to experience worse outcomes and higher rates of post-transplant mortality (Legaz, 2019). In particular, many studies have found that men who receive female donor livers are significantly more likely to experience graft failure than patients with other donor-recipient relationships (Lai, 2018). Little research exists on the relationship between donor sex and post-transplant outcome among individuals with ALD, specifically.
This study examines electronic health record data from a major transplant center in Atlanta, Georgia from the years 2013-2023 to identify the relationship between donor sex and post-transplant survival at 1 and 3 years in patients with Alcoholic Liver Disease. A number of potential covariates, including patient and donor age, donor circumstance of death, patient MELD score, and donor-recipient BMI difference were tested as potential mediators in the relationship between donor sex and survival.
The results of chi-square analysis found that contrary to the literature, female-female transplants performed significantly worse than other donor-recipient pairings, including female-male pairings. Stepwise logistic regression identified significant associations between female-female pairings and donor and recipient age, donor circumstance of death, and diabetes status. These covariates were not significant in explaining mortality rates in other donor-recipient pairing groups.
The existing literature suggests that among all-cause liver transplants, female-male pairings may experience poor outcomes due to a mismatch in estrogen levels between donor and recipient. This study hypothesizes that female-male transplants outperformed female-female transplants in this case due to the role of excessive alcohol consumption on estrogen production among recipients with ALD.
DOI
https://doi.org/10.57709/38132430
Recommended Citation
Mcguffey, Shannon, "Impacts of Donor Birth Sex on Liver Transplant Mortality among Individuals with Alcoholic Liver Disease (ALD)." Thesis, Georgia State University, 2025.
doi: https://doi.org/10.57709/38132430
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