Yitian Fang, Lisa B. Westenberg, Julie J. M. Hamm, Jacqueline van de Wetering, Stephan J. L. Bakker, Ron W. F. de Bruin, Robert A. Pol, Robert C. Minnee
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Transplantations were categorized into male donor-male recipient (MDMR, <i>n</i> = 476), female donor-male recipient (FDMR, <i>n</i> = 765), male donor-female recipient (MDFR, <i>n</i> = 463), and female donor-female recipient pairs (FDFR, <i>n</i> = 372). The primary outcome was graft survival. Secondary outcomes included patient survival, delayed graft function (DGF), acute rejection, and graft function.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The 10-year death-censored graft survival rates were 85.5% (MDMR), 85.4% (FDMR), 82.8% (MDFR), and 81.8% (FDFR) (<i>p</i> = 0.38), while corresponding 10-year patient survival rates were 73.3%, 70.7%, 74.8%, and 73.6%, respectively (<i>p</i> = 0.28). Male recipients had a slightly higher DGF rate compared to females (6.9% vs. 5.6%, <i>p</i> = 0.29). The incidence of acute rejection ranged from 15.5% to 18.3% across all combinations (<i>p</i> = 0.76). FDFR pairs in recipients ≥ 60 years had significantly better graft survival (95.9% vs. 86.6% vs. 87.0% vs. 80.7%, <i>p</i> = 0.048). Cox regression model confirmed this protective effect of female donor kidneys in aged female recipients (adjusted HR 0.24, 95% CI: 0.06–0.91, <i>p</i> = 0.036). MDMR pairs consistently showed superior long-term graft function but this advantage did not translate into better graft survival.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Female recipients aged 60 or older benefit from improved graft survival when receiving female donor kidneys. 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引用次数: 0
摘要
背景：供体和受体性别对活体肾移植（LDKT）的影响仍有争议。本研究调查了供体-受体性别组合对长期移植结果的影响。方法：在Erasmus医学中心（EMC）和格罗宁根大学医学中心（UMCG）进行双中心回顾性研究，纳入2010 - 2020年所有LDKT患者。移植分为男性供体-男性受体（MDMR, n = 476）、女性供体-男性受体（FDMR, n = 765）、男性供体-女性受体（MDFR, n = 463）和女性供体-女性受体（FDFR, n = 372）。主要结局是移植物存活。次要结局包括患者生存、移植物功能延迟（DGF）、急性排斥反应和移植物功能。结果：10年死亡剔除移植存活率分别为85.5% （MDMR）、85.4% （FDMR）、82.8% （MDFR）和81.8% (FDFR) (p = 0.38)，相应的患者10年生存率分别为73.3%、70.7%、74.8%和73.6% （p = 0.28）。男性接受者的DGF率略高于女性（6.9%对5.6%,p = 0.29）。急性排斥反应发生率为15.5% ~ 18.3% （p = 0.76）。≥60岁的FDFR受体组移植存活率显著提高（95.9% vs. 86.6% vs. 87.0% vs. 80.7%, p = 0.048）。Cox回归模型证实了女性供肾对老年女性受体的保护作用（校正后危险度0.24,95% CI: 0.06-0.91, p = 0.036）。MDMR对始终表现出优越的长期移植物功能，但这种优势并没有转化为更好的移植物存活率。结论：60岁或以上的女性受者接受女性供体肾脏后，移植肾存活得到改善。虽然MDMR对始终表现出优越的eGFR，但这种优势并不能转化为更好的移植物存活。
Impact of Donor and Recipient Sex on Long-Term Outcomes Following Living Donor Kidney Transplantation: A Retrospective Dual-Center Study
Background
The impact of donor and recipient sex on living donor kidney transplantation (LDKT) remains debated. This study investigates the impact of donor-recipient sex combinations on long-term transplant outcomes.
Methods
A dual-center retrospective study was conducted at Erasmus Medical Center (EMC) and University Medical Center Groningen (UMCG), including all LDKT patients between 2010 and 2020. Transplantations were categorized into male donor-male recipient (MDMR, n = 476), female donor-male recipient (FDMR, n = 765), male donor-female recipient (MDFR, n = 463), and female donor-female recipient pairs (FDFR, n = 372). The primary outcome was graft survival. Secondary outcomes included patient survival, delayed graft function (DGF), acute rejection, and graft function.
Results
The 10-year death-censored graft survival rates were 85.5% (MDMR), 85.4% (FDMR), 82.8% (MDFR), and 81.8% (FDFR) (p = 0.38), while corresponding 10-year patient survival rates were 73.3%, 70.7%, 74.8%, and 73.6%, respectively (p = 0.28). Male recipients had a slightly higher DGF rate compared to females (6.9% vs. 5.6%, p = 0.29). The incidence of acute rejection ranged from 15.5% to 18.3% across all combinations (p = 0.76). FDFR pairs in recipients ≥ 60 years had significantly better graft survival (95.9% vs. 86.6% vs. 87.0% vs. 80.7%, p = 0.048). Cox regression model confirmed this protective effect of female donor kidneys in aged female recipients (adjusted HR 0.24, 95% CI: 0.06–0.91, p = 0.036). MDMR pairs consistently showed superior long-term graft function but this advantage did not translate into better graft survival.
Conclusions
Female recipients aged 60 or older benefit from improved graft survival when receiving female donor kidneys. While MDMR pairs consistently exhibited superior eGFR, this advantage did not translate into better graft survival.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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