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

摘要

Objectives: 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. Materials and 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 1.4 ( P 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 con-cerning 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 charac-teristics and may not be related to sex itself.