Influence of donor and recipient gender on the outcome of liver transplantation.
BACKGROUND
Gender is currently not a criterion in the allocation of scarce donor organs. The purpose of this study was to determine the effects of gender on patient and graft survival, incidence of rejection, and postoperative complications after orthotopic liver transplantation.


METHODS
During a 10-year period, 1138 liver transplants were performed on 1010 adult patients at Baylor University Medical Center. In this study, 994 patients with at least 6 months of posttransplant follow-up were reviewed. The four combinations of gender match and mismatch included: group 1, donor female to recipient female (n=229); group 2, donor female to recipient male (n= 126); group 3, donor male to recipient female (n=247); and group 4, donor male to recipient male (n=392). These groups were evaluated for patient survival, graft survival, episodes of rejection, incidence of chronic rejection, and postoperative complications.


RESULTS
All groups were similar with respect to recipient age, underlying medical condition, incidence of bacterial and viral infections, postoperative biliary complications, and the incidence of chronic rejection. Female recipients had the highest incidence of early rejection (0-6 months, 70%) compared with male recipients (60%, P<0.039). Postoperative vascular complication (10%) was highest in group 3 (P<0.01). The two-year graft survival rate for groups 1, 3, and 4 was 76.2%, 75.6%, and 73.5%, respectively. Group 2, donor female to recipient male, had a 2-year graft survival rate of 55.9% (P<0.0001). This finding is not explained by the incidence of early rejection. Chronic rejection does not appear to be contributory. The mean donor age for groups 1, 3, and 4 was 35.7, 25.8, and 30.4 years, respectively. The mean donor age for group 2 was slightly older, at 41.6 years (P<0.0001). This difference, while statistically significant, is of unknown clinical relevance. A multivariate analysis controlling for donor age confirmed the decreased graft and patient survival rates in the donor female to recipient male group.


CONCLUSIONS
The decreased graft survival rate in male recipients of female livers warrants further study and may argue for modifying the current management of adult male liver transplant recipients.
Brooks
B K
BK
Transplantation Services, Baylor University Medical Center, Dallas, Texas 75246, USA.
Levy
M F
MF
Jennings
L W
LW
Abbasoglu
O
O
Vodapally
M
M
Goldstein
R M
RM
Husberg
B S
BS
Gonwa
T A
TA
Klintmalm
G B
GB
D000241:Adenosine; D000328:Adult; D000493:Allopurinol; D001424:Bacterial Infections / Q000453:epidemiology; D001660:Biliary Tract Diseases / Q000209:etiology; D005260:Female; D005783:Gender Identity; D005978:Glutathione; D006084:Graft Rejection; D006085:Graft Survival; D006304:Health Status; D006801:Humans; D006982:Hypertonic Solutions; D015994:Incidence; D007328:Insulin; D008107:Liver Diseases / Q000209:etiology / Q000503:physiopathology; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D008232:Lymphoproliferative Disorders / Q000209:etiology; D008297:Male; D009926:Organ Preservation / Q000379:methods; D019188:Organ Preservation Solutions; D044469:Racial Groups; D011887:Raffinose; D012727:Sex Characteristics; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000453:epidemiology
C037096:Euro-Collins' solution; D006982:Hypertonic Solutions; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose