Graft survival differences in kidney transplants related to recipient sex and age

Sancho, Asunción; Gavela, Eva; Kanter, Julia; Beltrán, Sandra; Castro, Cristina De; Escudero, Verónica; Pantoja, Jonay; Molina, Pablo; Vizcaíno, Belen; González, Mercedes; Calatayud, Elvira; Ávila, Ana

doi:10.3389/fmed.2022.962094

Cited by 5 publications

(5 citation statements)

References 36 publications

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“…It should be noted that the Taiwanese study included KT between 1988 and 2009, which was earlier than the last period in the present study. A recent study from Spain [ 18 ] showed lower graft survival for women under 60 years of age, which is more consistent with the present study.…”

Section: Discussionsupporting

confidence: 93%

Sex-specific time trends of long-term graft survival after kidney transplantation – a registry-based study

Nasic,

Peters,

Stegmayr

et al. 2023

Renal Failure

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Background Sex-specific trends over time with respect to kidney graft survival have scarcely been described in earlier studies. The present study aimed to examine whether kidney graft survival differs between women and men over time. Methods This study was based on prospectively collected data extracted from a quality registry including all kidney transplant patients between January 1965 and September 2017 at the transplantation center of a university hospital in Sweden. The transplantation center serves a population of approximately 3.5 million inhabitants. Only the first graft for each patient was included in the study resulting in 4698 transplantations from unique patients (37% women, 63% men). Patients were followed-up until graft failure, death, or the end of the study. Death-censored graft survival analysis after kidney transplantation (KT) was performed using Kaplan-Meier analysis with log-rank test, and analysis adjusted for confounders was performed using multivariable Cox regression analysis. Results Median age at transplantation was 48 years (quartiles 36–57 years) and was similar for women and men. Graft survival was analyzed separately in four transplantation periods that represented various immunosuppressive regimes (1965-1985, 1986–1995, 1996–2005, and 2006–2017). Sex differences in graft survival varied over time (sex-by-period interaction, p = 0.026). During the three first periods, there were no significant sex differences in graft survival. However, during the last period, women had shorter graft survival ( p = 0.022, hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.1–2.7, adjusted for covariates). Biopsy-proven rejections were more common in women. Conclusions In this registry-based study, women had shorter graft survival than men during the last observation period (years 2006–2017).

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Section: Discussionsupporting

confidence: 93%

Sex-specific time trends of long-term graft survival after kidney transplantation – a registry-based study

Nasic,

Peters,

Stegmayr

et al. 2023

Renal Failure

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“…Therefore, the data is contradictory and an association between male sex and declining eGFR is not clear in our dataset. Furthermore, strong evidence suggests that younger females are at higher risk of graft loss ( 59 – 61 ), which contradicts the results linking male sex to a sharper decline in kidney transplant function.…”

Section: Discussionmentioning

confidence: 90%

FOXP3 full length splice variant is associated with kidney allograft tolerance

Saleh,

Mohammadnejad,

Tepel

2024

Front. Immunol.

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BackgroundProgressive decline of allograft function leads to premature graft loss. Forkhead box P3 (FOXP3), a characteristic gene of T-regulatory cells, is known to be essential for auto-antigen tolerance. We assessed the hypothesis that low FOXP3 mRNA splice variant levels in peripheral blood cells early after transplantation are associated with progressive allograft injury.MethodsBlood samples were prospectively collected from 333 incident kidney transplant recipients on the first and 29th postoperative day. We used quantitative polymerase chain reaction to determine transcripts of 3 isotypes of FOXP3 splice variants, including pre-mature FOXP3 and full length FOXP3 (FOXP3fl). We investigated the association between FOXP3 splice variant levels and the declines in estimated glomerular filtration rate (eGFR) of more than 5ml/min/1.73m2 within the first-year post-transplant using logistic regression.ResultsWe observed lower FOXP3fl levels in recipients with declining eGFR (N = 132) than in recipients with stable eGFR (N = 201), (logarithmic value -4.13 [IQR -4.50 to -3.84] vs -4.00 [4.32 to -3.74], p=0.02). In ad hoc analysis pre-transplant FOXP3fl levels were similar in both groups. The association between FOXP3fl and declining eGFR was confirmed by multivariable analysis adjusted for potential confounding factors (Odds Ratio 0.51, 95% confidence interval 0.28 to 0.91: p=0.02). When stratifying FOXP3fl levels into quartiles, recipients with lower day1 FOXP3fl had the highest rate of declining eGFR (p=0.04).ConclusionLow FOXP3fl splice variant levels at the first postoperative day in kidney transplant recipients were associated with severe decline of eGFR, a well-known surrogate for hard endpoints.

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“…Over 45 years, the risk persisted but it was reduced to HR 0.95 (95% CI, 0.91–0.99). A decreased immune response associated with postmenopausal hormonal changes, adherence and reduced body mass were mentioned as explanations ( 34 ) Finally Sancho et al ( 35 ), in a retrospective study over one thousand patients, found that gender did not have an impact on graft outcomes. Chronic rejection in women and death with functioning graft were main reasons for graft loss.…”

Section: Outcome After Ktmentioning

confidence: 99%

Access to treatment in chronic kidney disease, dialysis and transplantation. Is there gender equality?

Sleiman,

Soler Pujol,

Montañez

et al. 2023

Front. Med.

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Sex and gender are often used as synonyms. However, while sex describes only a biological state, gender is a dynamic concept that takes into account psychosocial and cultural aspects of human existence that can change according to place and time. Inequality in medicine has been described in several areas. Among them, gender inequality has been disregarded for many years and is now a matter of concern. Chronic kidney disease (CKD) is a growing epidemic worldwide, affecting approximately 10% of the population. Although both men and women are affected, gender equality, especially in access to different treatments, is a matter of concern. We decided to investigate gender equality in patients with CKD. To this end, we conducted a literature narrative review to determine whether gender inequalities were found in CKD patients in general and in access to different treatment modalities in particular. A non-language restricted search was performed until November 30th 2022 in PubMed, SciELO, Trip Database, Google Scholar, MEDES y MEDLINE. We also investigated the situation in this regard in our country. We found that CKD is more prevalent in women than men, nevertheless this prevalence decreases along the CKD stages to the point that more men reach end stage kidney disease (ESKD) and dialysis. Access to transplant (ATT) is higher in men than in women although posttransplant survival shows no gender differences. Finally, most series have shown that women are more frequently Kidney transplantation (KT) living donors than men. Results in our country are similar to the published literature with the exception of a higher proportion of men as KT living donors. As in other areas, gender inequality in Nephrology has been largely overlooked. In this review we have highlighted gender differences in CKD patients. Gender inequality in Nephrology exists and needs to be looked upon in order to reach a personalized clinical approach.

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Graft survival differences in kidney transplants related to recipient sex and age

Cited by 5 publications

References 36 publications

Sex-specific time trends of long-term graft survival after kidney transplantation – a registry-based study

Sex-specific time trends of long-term graft survival after kidney transplantation – a registry-based study

FOXP3 full length splice variant is associated with kidney allograft tolerance

Access to treatment in chronic kidney disease, dialysis and transplantation. Is there gender equality?

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