Risk factors that increase mortality after living donor liver transplantation.
BACKGROUND
Female liver to male recipient is a well-accepted risk factor for graft loss in cadaveric liver transplantation. However, gender matching is infeasible because of an insufficient number of available donors. No studies have been performed on the role of gender in the field of living donor liver transplantation. This report investigates the effect of gender mismatch on the outcome of living donor liver transplantation.


METHODS
A total of 335 patients and donors were classified into four groups according to the following gender combinations: male donor to male recipient group (n=104), male donor to female recipient group (n=120), female donor to male recipient (FM) group (n=59), and female donor to female recipient group (n=52). Patient and graft survival were compared among the groups. We performed a multivariable analysis to identify the factors associated with patient mortality.


RESULTS
The 1-, 3-, 5-, and 10-year patient survival rates in the FM group were 80.6%, 66.8%, 61.8%, and 47.7%, respectively. The FM group showed significantly shorter patient survival compared with the other three groups. Independent risk factors for patient mortality were: FM group (P=0.006), pretransplant diabetes mellitus (P=0.001), and a model for end-stage liver disease score more than or equal to 20 (P=0.004).


CONCLUSIONS
Male recipients of transplants from female donors, pretransplant diabetes mellitus, and a model for end-stage liver disease score more than or equal to 20 have poor survival rates.
Department of Surgery and Multidisciplinary Treatment, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. yosizumi@surg2.med.kyushu-u.ac.jp
Tomoharu
T
Yoshizumi
Ken
K
Shirabe
Akinobu
A
Taketomi
Hideaki
H
Uchiyama
Noboru
N
Harada
Hideki
H
Ijichi
Masanori
M
Yoshimatsu
Toru
T
Ikegami
Yuji
Y
Soejima
Yoshihiko
Y
Maehara
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D015996:Survival Rate; D014180:Transplantation; D016896:Treatment Outcome; D055815:Young Adult