INFLUENCE OF DONOR AND RECIPIENT GENDER ON THE OUTCOME OF LIVER-TRANSPLANTATION

Background. Gender is currently not a criterion in the allocation of s carce donor organs, The purpose of this study was to determine the eff ects of gender on patient and graft survival, incidence of rejection, and postoperative complications after orthotopic liver transplantation . Methods. During a 10-year period, 1138 liver transplants were perfor med on 1010 adult patients at Baylor University Medical Center, In thi s study, 994 patients with at least 6 months of posttransplant follow- up were reviewed, The four combinations of gender match and mismatch i ncluded: group 1, donor female to recipient female (n=229); group 2, d onor female to recipient male (n=126); group 3, donor male to recipien t female (n=247); and group 4, donor male to recipient male (n=392). T hese groups were evaluated for patient survival, graft survival, episo des of rejection, incidence of chronic rejection, and postoperative co mplications. Results. All groups were similar with respect to recipien t age, underlying medical condition, incidence of bacterial and viral infections, postoperative biliary complications, and the incidence of chronic rejection, Female recipients had the highest incidence of earl y rejection (0-6 months, 70%) compared with male recipients (60%, P<0. 039), Postoperative vascular complication (10%) was highest in group 3 (P<0.01). The two-year graft survival rate for groups 1, 3, and 4 was 76.2%, 75.6%, and 73.5%, respectively. Group 2, donor female to recip ient male, had a 2-year graft survival rate of 55.9% (P<0.0001). This finding is not explained by the incidence of early rejection, Chronic rejection does not appear to be contributory, The mean donor age for g roups 1, 3, and 4 was 35.7, 25.8, and 30.4 years, respectively, The me an donor age for group 2 was slightly older, at 41.6 years (P<0.0001), This difference, while statistically significant, is of unknown clini cal relevance, A multivariate analysis controlling for donor age confi rmed the decreased graft and patient survival rates in the donor femal e to recipient male group. Conclusions. The decreased graft survival r ate in male recipients of female livers warrants further study and may argue for modifying the current management of adult male liver transp lant recipients.