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Influence of donor and recipient gender on the outcome of liver transplantation
RISKSFROMTHEDONOR
ELSEVIER
Influence of Donor and Recipient Gender on the Outcome of Liver Transplantation B.K. Brooks, M.F. Levy, L.W. Jennings, T.A. Gonwa, and G.B. Klintmalm
0. Abbasoglu,
G
ENDER IS currently not a criteria in the allocation of scarce donor organs. Although the number of cadaveric donors has increased slightly in recent years (5104 in 1994 to 4083 in 1988), during this same timeframe the number of cadaveric liver transplants increased from 1834 in 1988 to 4094 in 1994.’ This change reflects the increasing use of liver transplantation (OLTX) as a treatment modality, but without a concurrent matching increase in organ availability. An increasing use of older donors (~50 years of age) with the older donor now accounting for 22.6% of all cadaveric donors as compared with 11.7% in 1988, is largely responsible for the increase in liver availability.’ The influence of donor and recipient gender on outcomes following OLTX is unclear with varying results reported.2-6 We analyzed the effect of donor and recipient gender on patient and graft survival, incidence of: infection, acute cellular rejection. chronic rejection, and postoperative complications.
MATERIALS
AND
METHODS
Over a IO-year period 1138 liver transplants were performed on 1010 adult patients at our institution. This study reviews those 994 patients who have at least h months follow-up postOLTX. Gender was grouped into four specific categories: female to female, female to male, male to female, male to male, and two broad categories: gender match and gender mismatch. Estimates of patient and graft survivals were computed using the Kaplan-Meier method. Continuous data were compared using one way analysis of variance followed by the Bonferroni multiple comparisons procedure. Multivariate analysis using Cox Regression was utilized to verify the effects of significant variables (donor age and gender combina-
0 1997 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
Transplantation
Proceedings,
29, 475-476
(1997)
M. Vodapally,
R.M. Goldstein,
tions) on patient and considered significant.
graft
survival.
B.S. Husberg,
A P value
of <
.05 was
RESULTS
Mean recipient age was 46.4 years. The total number ot female recipients was 476 (47.4%) as compared to 518 male recipients (51.5%). Donor sex was: 355 (35.3%) female and 639 (63.6%) male. Mean donor age varied between the four gender groups: female to female, 35.7 years (n = 229); female to male, 41.6 years (n = 126); male to female, 25.8 years (n = 247); and male to male, 30.4 years (n = 392) (P 5 .OOOl). 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. No differences were noted among groups with respect to race, ischemia time, preservation solution. primary immunosuppression or UNOS status. Female recipients had the highest incidence of early rejection (0 to 6 months, 70%) as compared to male recipients (60%, P 5 .039). Postoperative vascular complications (10%) was highest in the donor male to recipient female group (P 5 .Ol). Two-year graft survival for the subgroups revealed: donor female to recipFrom the Transplantation Services, Baylor University Medical Center, Dallas, Texas. Funded, in part, by the Baylor University Medical Center Foundation. Address reprint requests to M.F. Levy, Transplantation Serv-4 Robert, Baylor University Medical Center, 3500 Gaston Avenue. Dallas, TX 75246.
0041-l 345/97/$17.00 PllSOO41-1345(96)00212-6
BROOKS, LEVY, JENNINGS ET AL
476
ient female, 76.2%; donor female to recipient male, 55.9%; donor male to recipient female, 75.6%; and donor male to recipient male, 73.5% (P 5 .OOOl). A multivariate analysis controlling for donor age confirmed these findings (P 5 .0025). This finding is not explained by the incidence of early rejection. Chronic rejection does not appear to be contributory.
male donor and female recipient.’
This was not reproduced
in our study. On the whole, the survival curves as described herein may have multifactorial etiology. Altering organ allocation based on this data is premature, impractical, and probably unwise in our day and age of such severe organ shortages.
REFERENCES
DISCUSSION
1. United Network for Organ Sharing. UNOS Update 12:13, 1996
The results of this study suggest that donor and recipient gender affects outcomes following OLTX. The gender mismatch combination of donor female to recipient male, while being the smallest groups of the four combinations, exhibited a higher percentage of graft failures and patient deaths. These findings were also noted by Marino, et al with respect to decreased graft survival of the male recipient of a female liver. They reported a decreased graft survival of all recipients of female donors which is contrary to our
5. Stratta RJ, Wood RP, Langnas AN, et al: Transplant Proc 22:410, 1990
findings.4 Other investigators incidence of chronic rejection
6. Kahn D, Zeng Q, Makowka L, et al: Hepatology 1989
have suggested an increased in the gender combination of
2. Kahn D, Dickson JS, Makowka L, et al: Digestive Dis Sci 38:1485, 1993 3. Candinas D, Gunson BK, Nightingale P, et al: Lancet 346: 1117,1995 4. Marion IR, Doyle HR, Aldrighetti 22:1154, 1995
L, et al: Hepatology
10:861,
ELSEVIER
Influence of Donor and Recipient Gender on the Outcome of Liver Transplantation B.K. Brooks, M.F. Levy, L.W. Jennings, T.A. Gonwa, and G.B. Klintmalm
0. Abbasoglu,
G
ENDER IS currently not a criteria in the allocation of scarce donor organs. Although the number of cadaveric donors has increased slightly in recent years (5104 in 1994 to 4083 in 1988), during this same timeframe the number of cadaveric liver transplants increased from 1834 in 1988 to 4094 in 1994.’ This change reflects the increasing use of liver transplantation (OLTX) as a treatment modality, but without a concurrent matching increase in organ availability. An increasing use of older donors (~50 years of age) with the older donor now accounting for 22.6% of all cadaveric donors as compared with 11.7% in 1988, is largely responsible for the increase in liver availability.’ The influence of donor and recipient gender on outcomes following OLTX is unclear with varying results reported.2-6 We analyzed the effect of donor and recipient gender on patient and graft survival, incidence of: infection, acute cellular rejection. chronic rejection, and postoperative complications.
MATERIALS
AND
METHODS
Over a IO-year period 1138 liver transplants were performed on 1010 adult patients at our institution. This study reviews those 994 patients who have at least h months follow-up postOLTX. Gender was grouped into four specific categories: female to female, female to male, male to female, male to male, and two broad categories: gender match and gender mismatch. Estimates of patient and graft survivals were computed using the Kaplan-Meier method. Continuous data were compared using one way analysis of variance followed by the Bonferroni multiple comparisons procedure. Multivariate analysis using Cox Regression was utilized to verify the effects of significant variables (donor age and gender combina-
0 1997 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
Transplantation
Proceedings,
29, 475-476
(1997)
M. Vodapally,
R.M. Goldstein,
tions) on patient and considered significant.
graft
survival.
B.S. Husberg,
A P value
of <
.05 was
RESULTS
Mean recipient age was 46.4 years. The total number ot female recipients was 476 (47.4%) as compared to 518 male recipients (51.5%). Donor sex was: 355 (35.3%) female and 639 (63.6%) male. Mean donor age varied between the four gender groups: female to female, 35.7 years (n = 229); female to male, 41.6 years (n = 126); male to female, 25.8 years (n = 247); and male to male, 30.4 years (n = 392) (P 5 .OOOl). 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. No differences were noted among groups with respect to race, ischemia time, preservation solution. primary immunosuppression or UNOS status. Female recipients had the highest incidence of early rejection (0 to 6 months, 70%) as compared to male recipients (60%, P 5 .039). Postoperative vascular complications (10%) was highest in the donor male to recipient female group (P 5 .Ol). Two-year graft survival for the subgroups revealed: donor female to recipFrom the Transplantation Services, Baylor University Medical Center, Dallas, Texas. Funded, in part, by the Baylor University Medical Center Foundation. Address reprint requests to M.F. Levy, Transplantation Serv-4 Robert, Baylor University Medical Center, 3500 Gaston Avenue. Dallas, TX 75246.
0041-l 345/97/$17.00 PllSOO41-1345(96)00212-6
BROOKS, LEVY, JENNINGS ET AL
476
ient female, 76.2%; donor female to recipient male, 55.9%; donor male to recipient female, 75.6%; and donor male to recipient male, 73.5% (P 5 .OOOl). A multivariate analysis controlling for donor age confirmed these findings (P 5 .0025). This finding is not explained by the incidence of early rejection. Chronic rejection does not appear to be contributory.
male donor and female recipient.’
This was not reproduced
in our study. On the whole, the survival curves as described herein may have multifactorial etiology. Altering organ allocation based on this data is premature, impractical, and probably unwise in our day and age of such severe organ shortages.
REFERENCES
DISCUSSION
1. United Network for Organ Sharing. UNOS Update 12:13, 1996
The results of this study suggest that donor and recipient gender affects outcomes following OLTX. The gender mismatch combination of donor female to recipient male, while being the smallest groups of the four combinations, exhibited a higher percentage of graft failures and patient deaths. These findings were also noted by Marino, et al with respect to decreased graft survival of the male recipient of a female liver. They reported a decreased graft survival of all recipients of female donors which is contrary to our
5. Stratta RJ, Wood RP, Langnas AN, et al: Transplant Proc 22:410, 1990
findings.4 Other investigators incidence of chronic rejection
6. Kahn D, Zeng Q, Makowka L, et al: Hepatology 1989
have suggested an increased in the gender combination of
2. Kahn D, Dickson JS, Makowka L, et al: Digestive Dis Sci 38:1485, 1993 3. Candinas D, Gunson BK, Nightingale P, et al: Lancet 346: 1117,1995 4. Marion IR, Doyle HR, Aldrighetti 22:1154, 1995
L, et al: Hepatology
10:861,