Donor, Recipient and Surgeon Sex and Sex-Concordance and their Impact on Liver Transplant Outcome

Abstract

(1) Background: Patient sex is associated with differential outcome of many procedures although the exact mechanisms remain unknown. Especially in transplant surgery, surgeon-patient sex-concordance is rarely present for female patients and outcome may be negatively affected. (2) Methods: In this single-center retrospective cohort study, recipient, donor, and surgeon sex were evaluated and short- and long-term outcome was analyzed with regards to sex and sex-concordance of patients, donors, and surgeons. (3) Results: We included 425 recipients in our study; 50.1% of organ donors, 32.7% of recipients, and 13.9% of surgeons were female. Recipient-donor sex concordance was present in 82.7% of female recipients and in 65.7% of male recipients (p = 0.0002). Recipient-surgeon sex concordance was present in 11.5% of female recipients and in 85.0% of male recipients (p < 0.0001). Five-year patient survival was comparable between female and male recipients (70.0% vs. 73.3%, p = 0.3978). Five-year patient survival of female recipients treated by female surgeons was improved without reaching significance (81.3% vs. 68.4%, p = 0.3621). (4) Conclusions: Female recipients and female surgeons are underrepresented in liver transplant surgery. Societal factors influencing outcome of female patients suffering from end-stage organ failure need to be further examined and acted upon to possibly improve the outcome of female liver transplant recipients.

Association of surgeon−patient sex concordance with postoperative outcomes following complex cancer surgery

“…54 Although these findings suggested differences in practice patterns between male and female physicians, few studies have examined the association of provider−patient sex concordance (or discordance) with postoperative outcomes. 1,37 Wallis et al did report that sex discordance was associated with worse postoperative outcomes among patients undergoing elective general surgery procedures. 1 In the current study, we similarly noted that sex discordance was associated with differences in perioperative surgical outcomes.…”

“…In a separate study, Gross et al noted that sex concordant provider−patient relationship was associated with better patient rapport, while a sex discordant provider−patient relationship correlated with a higher diagnostic uncertainty 54 . Although these findings suggested differences in practice patterns between male and female physicians, few studies have examined the association of provider−patient sex concordance (or discordance) with postoperative outcomes 1,37 . Wallis et al did report that sex discordance was associated with worse postoperative outcomes among patients undergoing elective general surgery procedures 1 .…”

“…Sex concordance was defined as a patient of male sex treated by a male surgeon or a patient of female sex treated by a female surgeon. Sex discordance was defined as a patient of female sex treated by a male surgeon or a patient of male sex treated by a female surgeon 1,37 …”

“…Sex discordance was defined as a patient of female sex treated by a male surgeon or a patient of male sex treated by a female surgeon. 1,37 The primary outcome of interest was the textbook outcome (TO), a composite measurement of desirable postoperative outcomes, which includes no 30-day complications at index surgery, no 90-day mortality, no prolonged length of hospital stay (<75th percentile for each procedure), and no readmission within 90 postoperative days. 38 Complications were defined as respiratory failure, pneumonia, myocardial infarction, venous thromboembolic disease, acute renal failure, gastrointestinal bleeding, postoperative hemorrhage, and surgical site infection (Supporting Information S1: Table 3).…”