THE EFFECT OF DONOR GENDER ON RENAL-ALLOGRAFT SURVIVAL

Donor gender plays a role in the outcome of renal transplantation, but the mechanisms responsible for this effect are unclear. In this study , actuarial graft survival in 1049 recipients transplanted at Montefio re Medical Center between 1979 and 1994 was examined. It was found tha t donor gender had no influence on graft survival in recipients treate d with precyclosporine immunosuppressive agents. In contrast, graft su rvival time was greater in cyclosporine-treated recipients of male don or kidneys compared with female kidneys (P < 0.05). This survival time difference was evident in the early post-transplant period and was en tirely accounted for by the survival advantage of kidneys from white m ale donors. There was no gender-related difference in graft survival t ime among recipients of African-American donor kidneys. Recent attenti on has focused on the hypothesis that a mismatch between female donor kidney nephron supply and male recipient functional demand results in hyperfiltration-mediated glomerular injury and that this is responsibl e for reduced survival time of female allografts. Any hypothesis purpo rting to explain gender-related differences in graft survival time mus t take into account this study's observations that the donor-gender ef fect was observed only in cyclosporine-treated recipients, was not see n in African-American donors, appeared soon after renal transplantatio n, and did not increase progressively with time, These observations ar e most consistent with the hypothesis that gender-related differences in graft survival time may reflect differences in susceptibility to cy closporine nephrotoxicity or differences in the therapeutic response t o cyclosporine.