Donor-Recipient Gender and Size Mismatch Affects Graft Success after Kidney Transplantation

Abstract

Background Female recipients of male kidneys have an inferior graft survival, and patients receiving larger kidneys relative to their body size may have a graft survival advantage. Thus, graft survival may be affected by both gender and kidney size mismatches. The objective of this study was to analyze the possible confounding effect of body mass mismatch (body mass as proxy for kidney size) between female recipients of male donor kidneys. Study Design A total of 668 kidney transplants between 1996 and 2005 at our center were studied retrospectively. Graft and patient survival were determined by Kaplan-Meier estimation. Multivariate Cox proportional analyses were performed to determine the hazards of graft loss. Results There were 146 female recipients of male kidneys. Compared to all gender combinations, this group had the lowest, unadjusted graft survival (86%, 79%, and 78% vs. 92%, 88%, and 86% at 1, 2, and 3 years, respectively, log-rank p=0.01). Donor body mass index (BMI) correlated with donor kidney size (p<0.001). Male kidneys were a risk factor of graft loss for female recipients (hazard ratio [HR] 3.45, 95% CI 1.40–8.51, p=0.01), but male donors with a larger BMI relative to female recipients’ significantly reduced the risk (HR 0.19, 95% CI 0.05–0.67, p=0.01). Conclusions The inferior graft survival for female recipients of male donor kidneys is mitigated by male donors with a larger BMI.

Improved renal ischemia tolerance in females influences kidney transplantation outcomes

“…DGF is the functional result of IRI in clinical renal transplantation and is defined as a requirement for dialysis within 7 days of transplantation (5). Given the sexual dimorphism of renal IRI tolerance observed in mice, we postulated that female sex would be protective against DGF and that donor-recipient size discrepancy would not account for these differences, as has been previously considered (1). To examine this hypothesis, we analyzed deceased donor renal transplants from United Network for Organ Sharing (UNOS) national registry data from 2009 to 2014, with DGF as the outcome of interest using uni-and multivariable Cox regression analysis.…”

“…Sex-based differences are ascribed to donor-recipient size mismatching and exposure to H-Y minor histocompatibility (1)(2)(3)(4). However, a focus on size-and immune-mediated effects has ignored the association between sex and ischemia-reperfusion injury (IRI).…”

The Allo-Immunological Injury in Chronic Allograft Nephropathy

“…Due to lack of the Y chromosome in women, antigens coded for by the Y chromosome are recognized as foreign when organ transplantation occurs from a male donor to a female recipient (McGee et al, 2010(McGee et al, , 2011. While this does not manifest immunologically as strongly as HLA incompatibility, it does have an effect of having shorter graft survival when an organ is taken from a male donor and transplanted to a female recipient (McGee et al, 2010).…”

“…While this does not manifest immunologically as strongly as HLA incompatibility, it does have an effect of having shorter graft survival when an organ is taken from a male donor and transplanted to a female recipient (McGee et al, 2010). This effect is more strongly noted among bone marrow transplants, but is also present to some degree in solid organ transplants such as the kidney (Gratwohl et al, 2008).…”

Donor kidney glomerular filtration rate and donor/recipient body surface area ratio influence graft function in living related kidney transplantation

“…Body size is another important independent predictor for kidney volume and GFR. 11,12 Poggio et al 13 reported a strong correlation between donor body surface area (BSA) and renal function. Lee et al 14 indicated that graft kidney volume/ recipient BSA ratio was a predictor of graft function 12 months after kidney transplantation.…”