In living donor kidney transplantation there are disproportionately more female-to-male donations and fewer male-to-female donations. Given the rapid increase in living donor transplantation, we studied gender demographics and outcomes of these transplants. We analyzed living donor kidney transplants in the Scientific Registry of Transplant Recipients (SRTR) database between 1990 and 1999. There were 30 258 living donor transplants [26 510 (87%) biologically related; 2367 (8%) spousal; 1381 (5%) nonspousal unrelated]. Females comprised 68% of spousal and 56% of related and unrelated nonspousal donors (p < 0.0001). The distributions of gender pairings in nonspousal groups (related and unrelated) were significantly imbalanced (p < 0.0001). Opposite-sex pairs demonstrated more female-to-male donations among living related (64%, p < 0.0001), unrelated nonspousal (65%, p < 0.0001), and spousal pairs (68%). The higher incidence of end-stage renal disease among males and the slight predominance of females in the general population did not explain these gender disparities. Male recipients of male donor kidneys demonstrated significantly higher graft survival than other combinations (p < 0.006). Gender disparities in living donor transplantation result from a higher proportion of wife-to-husband donations and disproportionate female-to-male donations among biological relatives and unrelated pairs. There appears to be a graft survival advantage for male recipients of male donor kidneys.

We studied pediatric liver transplantation for metabolic disease in a large national cohort to determine whether smaller studies suggesting a survival advantage for these recipients could be corroborated. We also hoped to determine whether higher survival rates in recipients with metabolic disease are associated with lack of structural liver disease, and to evaluate these recipients' risk factors for mortality. Data from the Scientific Registry of Transplant Recipients were used to analyze nationwide results (1990±99) of pediatric liver transplantation for patients with biliary atresia and metabolic disease. Adjusted patient survival rates for children with metabolic disease at 1 and 5 years were 94% and 92%, respectively, ± significantly higher than for recipients with biliary atresia (90% and 86%) (p=0.008). Cox regression models identified recipient black race [relative risk (RR) = 5.1] and simultaneous transplantation of other organs (RR = 3.2) as significant risk factors for mortality in the metabolic group. Adjusted survival rates for metabolic patients with structural and nonstructural liver diseases were similar to each other at both 1 and 5 years. Children with metabolic disease had significantly higher adjusted short-and long-term post-transplant survival rates than those with biliary atresia. Structural disease was not a risk factor for worse outcomes.