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Title: Low-serum testosterone levels pre-liver transplantation are associated with reduced rates of early acute allograft rejection in men.
Austin Authors: Sinclair, Marie ;Angus, Peter W ;Gow, Paul J ;Hoermann, Rudolf;Mogilevski, Tamara;Grossmann, Mathis 
Affiliation: 4 Address correspondence to: Marie Sinclair, Liver Transplant Unit, Austin Health, 145 Studley Road, Heidelberg, Victoria, Australia 3084.
3 Endocrine Unit, Austin Health, Heidelberg, Victoria, Australia
1 Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 15-Oct-2014
Publication information: Transplantation; 98(7): 788-92
Abstract: Low pretransplant serum testosterone has recently been associated with increased mortality in men awaiting liver transplantation, but the potential impact on rejection has not yet been investigated.Pretransplantation serum testosterone, SHBG, and other variables were collected on 190 consecutive men who received a liver transplant between 2007 and 2013. Rates of subsequent acute cellular rejection were recorded. Multivariable analysis was performed to define variables associated with rejection and other clinically important end points.Thirty (16%) of 190 men experienced acute cellular rejection. Lower pretransplant testosterone was associated with lower rejection rates, -7% (95% confidence interval [CI], -2% to -12%) per nmol/L decrease in total testosterone and -4% (95% CI, -0.5% to -7%) per 10 pmol/L decrease in free testosterone. Total testosterone (correlation 0.29, P=0.04) and free testosterone (correlation 0.37, P=0.01) correlated significantly with the histological severity of rejection. Older age at transplant (+5% [95% CI, 9%-2%]) per year, and nonautoimmune etiology of liver disease (OR, 1.0 for autoimmune, 0.22 [95% CI, 0.07-0.73] for hepatitis C virus, and 0.58 [95% CI, 0.21-1.71] for other etiologies) were also associated with decreased rejection risk. In a generalized linear model including the covariates testosterone, SHBG, age, etiology, and MELD, total testosterone remained a significant predictor of rejection (adjusted OR, 1.06; P=0.03), as did age at transplant (OR, 0.95; P=0.01).Low preliver transplant serum testosterone independently predicts a decreased risk of acute allograft rejection. Whether testosterone is a marker of disease-associated immune dysfunction or has immune-modulatory effects requires further study.
Gov't Doc #: 24918618
DOI: 10.1097/TP.0000000000000130
Type: Journal Article
Subjects: Adult
Biological Markers.blood
Databases, Factual
End Stage Liver
Graft Rejection.blood
Immunosuppressive Agents.therapeutic use
Length of Stay
Liver Transplantation
Middle Aged
Multivariate Analysis
Severity of Illness Index
Treatment Outcome
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