title: The Influence of Donor and Recipient Gender Incompatibility on Corneal Transplant Rejection and Failure.
abstract: In vascularized organ transplants, gender mismatches have higher rates of immunological rejection. We investigated the influence of gender incompatibility, including H-Y incompatibility, on corneal transplant graft rejection and failure. Patients were included who had undergone a first corneal transplant for keratoconus (KC), Fuchs endothelial dystrophy (FED), pseudophakic bullous keratopathy (PBK), infection and other indications. A Cox regression model was fitted for each indication to determine factors affecting graft failure and rejection at 5 years. The impact of gender, including H-Y, matching was analyzed after accounting for other factors, including known risk factors. Of 18 171 patients, 4314 had undergone a transplant for FED, 4783 for KC, 3669 for PBK, 1903 for infection and 3502 for other disorders. H-Y mismatched (male [M]→female [F]) corneas were at greater risk of graft failure or rejection. For FED, F→F were 40% less likely to fail (p < 0.0001) and 30% less likely to reject (p = 0.01); M→M were 20% less likely to fail (p = 0.04) and 30% less likely to reject (p = 0.01). For KC, M→M matched corneas were 30% less likely to fail (p = 0.05) and 20% less likely to reject (p = 0.01) compared with H-Y mismatches. H-Y antigen mismatched (M→F) patients were at greater risk of rejection or graft failure.
authors.affiliation: NHS Blood and Transplant, Statistics and Clinical Studies, Bristol, UK.
authors.forename: C L
authors.initials: CL
authors.lastname: Hopkinson
authors.affiliation: Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: V
authors.initials: V
authors.lastname: Romano
authors.affiliation: Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Kaye
authors.affiliation: Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: B
authors.initials: B
authors.lastname: Steger
authors.affiliation: Royal Liverpool University Hospital, Liverpool, UK.|Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.
authors.forename: R M K
authors.initials: RM
authors.lastname: Stewart
authors.affiliation: Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: M
authors.initials: M
authors.lastname: Tsagkataki
authors.affiliation: NHS Blood and Transplant, Statistics and Clinical Studies, Bristol, UK.
authors.forename: M N A
authors.initials: MN
authors.lastname: Jones
authors.affiliation: NIHR Clinical Research Facility, Moorfields Eye Hospital, London, UK.
authors.forename: D F P
authors.initials: DF
authors.lastname: Larkin
authors.affiliation: Royal Liverpool University Hospital, Liverpool, UK.|Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.
authors.forename: S B
authors.initials: SB
authors.lastname: Kaye
mesh_terms: D000328:Adult; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D014019:Tissue Donors; D066027:Transplant Recipients
keywords: clinical research/practice; corneal transplantation/ophthalmology; gender; graft survival; histocompatibility; minor histocompatibility molecules; rejection