Gender and Autoimmune Liver Diseases: Relevant Aspects in Clinical Practice

Abstract

Autoimmune liver diseases (AILDs) include autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis. The etiologies of AILD are not well understood but appear to involve a combination of genetic and environmental factors. AILDs commonly affect young individuals and are characterized by a highly variable clinical course. These diseases significantly influence quality of life and can progress toward liver decompensation or the onset of hepatocellular or cholangiocarcinoma; a significant number of patients eventually progress to end-stage liver disease, requiring liver transplantation. In this review, we focus on the sex characteristics and peculiarities of AILD patients and highlight the relevance of a sex-specific analysis in future studies. Understanding the sex differences underlying AILD immune dysregulation may be critical for developing more effective treatments.

The role of donor sex on the post-liver transplant outcomes in patients with primary sclerosing cholangitis

“…The interaction between sexes in general LT studies has been shown to affect post-transplant results, particularly in graft survival [23]. However, no studies have been conducted to determine the relationship between donor and recipient sexes after LT in patients with PSC, where sex is known to play a role in the epidemiology of this disease [17,18].…”

“…In particular, several non-PSC liver transplant studies have identified recipient-donor sex mismatch to confer a modified risk to post-LT prognosis, potentiating early demise of grafted livers and causing intrinsic graft complications [15,16]. Given that PSC has been associated with differential prognostic and disease-development patterns based on sex [17,18], it is essential to investigate the differences in post-LT prognosis due to sex differences or sex mismatch between recipients and donors.…”

Primary Biliary Cholangitis, Liver Transplantation, and Hepatocellular Carcinoma: A Mini-review

“…One of the most widely recognized clinical characteristics of PBC is a strong female preponderance. 37 Multiple studies showed that male gender is associated with a delay in diagnosis and, as a result, an increased age at PBC identification. [37][38][39] Multiple studies have shown that fatigue is more likely to be associated with female sex at the time of PBC presentation.…”

“…37 Multiple studies showed that male gender is associated with a delay in diagnosis and, as a result, an increased age at PBC identification. [37][38][39] Multiple studies have shown that fatigue is more likely to be associated with female sex at the time of PBC presentation. 37 Additionally, several studies demonstrated that an inadequate response to UDCA is more prevalent in males than in females.…”

“…[37][38][39] Multiple studies have shown that fatigue is more likely to be associated with female sex at the time of PBC presentation. 37 Additionally, several studies demonstrated that an inadequate response to UDCA is more prevalent in males than in females. 38,40 However, other researches have shown that sex difference has no impact on UDCA therapy response.…”