title: Gender Matches in Liver Transplant Allocation: Matched and Mismatched Male-Female Donor-Recipient Combinations; Long-term Follow-up of More Than 2000 Patients at a Single Center.
abstract: OBJECTIVE
  The influence of donor-recipient sex mismatches on long-term graft survival after liver transplant is controversial. In this study, our aim was to characterize the differences in long-term graft outcome after liver transplant in more than 2000 cases with special regard to sex match and mismatch.
  
  
  METHODS
  In this retrospective, single center study of 2144 adult primary liver transplant recipients (median follow-up of 92 months), we analyzed specific long-term graft survival and the effect of different donor and recipient sex combinations (Kaplan-Meier, multivariate regression).
  
  
  RESULTS
  In the 15-year follow-up, female recipients (58.6%) had significantly better graft survival than male recipients did (51.6%, P = .031). Matched and mismatched male-female combinations revealed significant differences (P = .003): a male donor-female recipient combination showed the best 15-year graft survival (61.1%), and a female donor-male recipient combination showed the worst graft survival (48.6%), whereas male-male (53.3%) and female-female combinations (55.6%) were not significantly different (P = .967). Donor age (P ≤ .0001), body mass index (P = .021), female sex (P = .015), Eurotransplant Donor Risk Index > 1.4 (P ≤ .001), recipients' age (P < .0001), indication for liver transplant (P < .0001), and kidney function (P = .003) significantly affected graft survival. In the multivariate analysis model, a Eurotransplant Donor Risk Index > 1.4 and impaired kidney function at liver transplant again emerged as significant negative predictors. Female donors and male recipients showed significantly more unfavorable characteristics concerning long-term graft survival.
  
  
  CONCLUSIONS
  The impressive long-term graft survival benefit of male donor-female recipient versus female donor-male recipient and of male donor-female recipient versus matched groups (male-male, female-female) in liver transplant may be caused by significant differences in donor quality and recipient characteristics and may not be related to sex itself.
authors.affiliation: From the Department of General, Visceral, and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany; and the Department of General, Visceral, and Transplantation Surgery, University Hospital of RWTH, Aachen, Germany.
authors.forename: Wenzel N
authors.initials: WN
authors.lastname: Schoening
authors.forename: Michael
authors.initials: M
authors.lastname: Helbig
authors.forename: Niklas
authors.initials: N
authors.lastname: Buescher
authors.forename: Andreas
authors.initials: A
authors.lastname: Andreou
authors.forename: Marcus
authors.initials: M
authors.lastname: Bahra
authors.forename: Volker
authors.initials: V
authors.lastname: Schmitz
authors.forename: Andreas
authors.initials: A
authors.lastname: Pascher
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
mesh_terms: D000328:Adult; D005260:Female; D005858:Germany; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D066027:Transplant Recipients; D016896:Treatment Outcome