Gender Differences in Self- versus Clinician-Rated Global Health Status among Liver Transplant Candidates

Abstract

Purpose: Gender differences in liver transplant outcomes exist: females experience higher rates of wait-list mortality and, among hepatitis C-infected (HCV) recipients, have higher rates of acute rejection and posttransplant mortality. We hypothesized that patient- or clinician-perceived health status may be contributing to these outcomes. The aim of this study was to explore gender differences in perceived health status. Methods: All outpatients ≥18 years listed for LT with model for end-stage liver disease (MELD)≥12 at a single center underwent a structured assessment of global functional status (“Frailty Score”) [Fried Instrument; range: 0-5] at baseline. Patients (self-assessment) and their clinicians (MD-assessment) were then asked to grade the patient's global health status on a range of excellent (0) to fair (3), to very poor (5) without knowledge of the frailty score. Correlations were assessed by the Pearson's correlation coefficient (r). Results: One hundred sixty-two listed LT outpatients with MELD≥12 had a mean [standard deviation(SD)] age of 57 years (10), 57% were White, 52% had HCV, and 20% had hepatocellular carcinoma (HCC). Mean (SD) MELD was 17 (5), frailty score was 1.5 (1.1). Compared to the 115 (71%) males (M), the 47 (29%) females (F) were older (59 vs. 56; p=0.03), but were similar by % HCV, % HCC, and MELD score. F vs. M were more frail by frailty score (1.9 vs. 1.4; p<0.01) and MD-assessment scores (2.7 vs. 2.2; p=0.04), but self-assessment scores were similar (3.5 vs. 3.3; p=0.25). The correlation between MD-assessment and frailty score among M was weak (r=0.27; p<0.01), but stronger among F (r=0.47; p<0.01). The correlation between self-assessment and frailty scores among M (r=0.46; p<0.01) and F (r=0.41; p<0.01) was similar. The correlation between MD-assessment and self-assessment was weak for both M (r=0.34; p<0.01) and F (r=0.30; p<0.01). Conclusion: Female LT candidates are more frail than males by an objective measure of frailty. Despite this difference, self-rated global health status was similar by gender. Clinician-rated global health status was more strongly correlated for female than male LT candidates. Whether these gender differences in patient- and clinician-perceived global health status contribute to outcomes in liver transplantation warrant further study.