Organ transplantation and gender differences: a paradigmatic example of intertwining between biological and sociocultural determinants

Puoti, Francesca; Ricci, A.; Nanni-Costa, A.; Ricciardi, Walter; Malorni, Walter; Ortona, Elena

doi:10.1186/s13293-016-0088-4

Cited by 78 publications

(79 citation statements)

References 19 publications

(19 reference statements)

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“…And our observed lower likelihood of LD transplantation for women is consistent with the well documented higher proportion of female‐to‐male compared to male‐to‐female LD . These gender discrepancies likely represent a complex of biological and socio‐cultural determinants . Segev et al reported that age and comorbidities were effect modifiers of gender disparities in access to renal transplantation in the US population, concluding that there was no disparity for women in general but rather marker disparity for older women and those with comorbidities .…”

Section: Discussionsupporting

confidence: 88%

“…38 These gender discrepancies likely represent a complex of biological and socio-cultural determinants. [39][40][41] Segev et al reported that age and comorbidities were effect modifiers of gender disparities in access to renal transplantation in the US population, concluding that there was no disparity for women in general but rather marker disparity for older women and those with comorbidities. 37 We saw the effect size of female gender increase in our multivariate model compared with univariate analysis (SHR 0.85 vs 0.91); however, the exploration of effect modifiers was beyond the scope of this paper.…”

Section: Discussionmentioning

confidence: 99%

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Access to waitlisting for deceased donor kidney transplantation in Australia

et al. 2019

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Access to waitlisting for deceased donor kidney transplantation in Australia

et al. 2019

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“…The finding that male sex serves an independent prognostic factors for the progression to allograft failure is in line with previous studies which reported that recipient male gender confers a worse prognosis for allograft survival in a large retrospective cohort [27]. This gender differences may partially be explained by the fact that women are protected by hormones and appear to be more compliant than male recipients [28,29]. Other clinical parameters predicting outcome at the univariate analysis, i.e.…”

Section: Discussionsupporting

confidence: 88%

Proteinuria, Estimated Glomerular Filtration Rate and Urinary Retinol-Binding Protein as Clinical Predictors of Long-Term Allograft Outcomes in Transplant Glomerulopathy

Chen

Cheng

et al. 2018

Kidney Blood Press Res

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Background/Aims: We aimed to explore the associations between clinical parameters and long-term allograft outcomes in transplant glomerulopathy (TG) in a large retrospective cohort with long follow-up. Methods: Clinical and laboratory data at biopsy from 180 cases of TG with an estimated glomerular filtration rate (eGFR)> 15ml/min/1.73m² from January 2004 to December 2016 at our center were retrospectively analyzed. The main outcome of this study was initiation of replacement therapy or an eGFR declined to < 15 ml/min/1.73m². Results: During a median follow-up of 5 years (interquartile range 2.6-8.2 years), 117 cases (65.0%) achieved the combined event. Kaplan-Meier method yielded the 1-year and 5-year cumulative renal allograft survival rates after a histopathologic diagnosis of TG were 84% (95% confidence interval [CI] 81-87%) and 33% (95% CI 27–39%) respectively. In univariate analysis, allograft outcome differed significantly by eGFR, proteinuria, blood hemoglobin level, urinary retinol-binding protein (urRBP) and urinary N-acetyl-β-D-glucosaminidase (urNAG) level at the time of biopsy. Multivariate Cox analysis revealed that a higher level of eGFR was the most powerful predictor of allograft survival. Compared with those with eGFR≥60, the hazard ratio (HR) increased from 4.50 (95% CI: 1.03-19.71, p=0.0462) for patients with eGFR between 30 and 59 ml/min/1.73m² to 9.14 (95% CI 1.97-42.45, P=0.0047) when eGFR decreased to 15 to 29 ml/min/1.73m². Additionally, proteinuria and higher urRBP values (≥2.85mg/dl) were found to confer much worse survival rates for TG patients in multivariate Cox analysis. Male sex (HR 0.48, P=0.02) and HCV infection (HR 1.78, P=0.0499) were also found to be independent risk factors for worse allograft survival. Conclusion: Five clinical features—impaired renal function, higher proteinuria, higher urRBP level, male sex and HCV infection—are independent predictors of an unfavorable renal allograft outcome. urRBP is a simple and useful parameter that can add invaluable information for the clinical follow-up of patients with TG.

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“…Although gender difference in heart transplantation regarding the incidence of AMR and mortality has been described, 11 these results were derived from large retrospective registry studies. 9,12 However, because of the size of these databases, important confounding variables such as pfDSA could not be taken into account.…”

Section: Discussionmentioning

confidence: 99%

Effect of recipient gender and donor-specific antibodies on antibody-mediated rejection after heart transplantation

Nguyen

Coutance

Salem

et al. 2019

American Journal of Transplantation

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Gender‐difference regarding antibody‐mediated rejection (AMR) after heart transplantation has been described. However, no study accounted for the presence of preformed donor‐specific antibodies (pfDSA), a known risk factor of AMR, more common among women than men. In a single‐institution 6‐year cohort (2010‐2015), time to AMR was assessed, comparing men with women by survival analysis with a 1‐year death‐censored follow‐up. All AMRs were biopsy proven. Confounding variables that were accounted for included mean intensity fluorescence (MFI) of pfDSA, recipient age, HLA‐, size‐ and sex‐mismatch. 463 patients were included. Overall incidence of AMR was 10.3% at 1 year. After adjusting for confounding variables, independent risk factors of AMR were female recipient gender (adjusted hazard‐ratio [adj. HR] = 1.78 [1.06‐2.99]), P = .03) and the presence of pfDSA (adj. HR = 3.20 [1.80‐5.70], P < .001). This association remained significant when considering pfDSA by their MFI; female recipient gender had an adj. HR = 2.2 (P = .026) and MFI of pfDSA (per 1 MFI‐increase) adj. HR = 1.0002 (P < .0001). In this cohort, women were at higher risk of AMR than men and this risk increase was additive to that of pfDSA. These findings may suggest a gender‐related difference in the severity of pfDSA.

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Organ transplantation and gender differences: a paradigmatic example of intertwining between biological and sociocultural determinants

Cited by 78 publications

References 19 publications

Access to waitlisting for deceased donor kidney transplantation in Australia

Access to waitlisting for deceased donor kidney transplantation in Australia

Proteinuria, Estimated Glomerular Filtration Rate and Urinary Retinol-Binding Protein as Clinical Predictors of Long-Term Allograft Outcomes in Transplant Glomerulopathy

Effect of recipient gender and donor-specific antibodies on antibody-mediated rejection after heart transplantation

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