Influence of donor and recipient gender on the outcome of liver transplantation

Brooks, Barbara K.; Levy, Marlon F.; Jennings, L W; Abbasoğlu, Osman; Vodapally, Mohan S.; Goldstein, Robert M.; Husberg, Bo S.; Gonwa, Thomas A.; Klintmalm, Göran B.

doi:10.1016/s0041-1345(96)00212-6

Cited by 47 publications

(57 citation statements)

References 3 publications

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“…Kahn (36) reported that no less than 60% of livers from female donors failed in male recipients, corresponding to a 3.7-fold higher risk of graft failure. Data from the UNOS registry (37) and several other series confirmed inferior graft and patient survival in males receiving the liver from a female donor (38). Our data confirm this effect in North American centers, but for unknown reasons, no such effect was seen in Western Europe.…”

Section: Discussionsupporting

confidence: 74%

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The Effect of Donor Gender on Graft Survival

Zeier¹,

Döhler

Opelz

et al. 2002

Journal of the American Society of Nephrology

227

163

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ABSTRACT. Differences in actuarial graft survival according to donor gender have been reported for renal allografts and for cardiac and hepatic allografts, but for the latter in small series with limited biostatistical power. Using the large database of the Collaborative Transplant Study (CTS), this study is an evaluation of graft survival according to donor and recipient gender for renal (n = 124,911), cardiac (n = 25,432), and hepatic (n = 16,410) transplants. Confounders, such as calendar year, geographical area, race, donor and recipient age, HLA mismatch, cold ischemia time, and others, as well as interaction terms were taken into consideration. Death-censored actuarial renal allograft survival from female compared with male donors was less in female recipients and even more so in male recipients. The donor gender-associated risk ratio for graft loss was 1.15 in female recipients and 1.22 in male recipients. The age-gender interaction term was statistically significant, the gender effect being more pronounced for younger (16 to 45 yr) compared with older (>45 yr) donors. Serum creatinine concentrations 1 yr after transplantation were also higher for recipients with kidney grafts coming from female donors irrespective of recipient gender. For first cardiac transplants, graft survival was inferior when the donor was female and the recipient male, but no statistical difference according to donor gender was demonstrable in female recipients. For first hepatic transplants overall, no significant differences according to donor gender were noted. The proportion of recipients who had treatment for rejection crisis during the first year was higher for male recipients of kidneys from female donors compared with male donors. No difference according to donor gender was demonstrable in female recipients. For cardiac and hepatic grafts, no significant effect of donor gender on the proportion of patients treated for rejection episodes was noted. The data show that adverse effects of female donor gender for different organs is much less uniform than reported in the past. An important confounder is donor age. A gender effect on graft survival is also observed for cardiac allografts. Therefore, in addition to potential “nephron underdosing,” further pathomechanisms must play a role, possibly differences in immunogenicity according to donor gender. E-mail: martin_zeier@med.uni-heidelberg.de

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Section: Discussionsupporting

confidence: 74%

“…On the basis of results in small series it has also been claimed that graft outcome was worse for heart and liver allografts coming from female donors (33)(34)(35)(36)(37)(38).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Donor Gender on Graft Survival

Zeier¹,

Döhler

Opelz

et al. 2002

Journal of the American Society of Nephrology

227

163

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“…Estudos em países desenvolvidos sugerem que fatores de risco sócio-econômicos, demográficos e clínicos dos receptores aumentam o risco de falência do transplante hepático, principalmente as faixas etárias extremas 17 , a raça negra 18 , o gênero feminino 19 , doença hepática viral grave, paciente com classificação ChildPugh grau C 20 , renda familiar e escolaridade baixa 21,22,23 . Entre os fatores do doador, destacam-se: o óbito por doenças cérebro-vasculares 9,24,25 , idades extremas 26 , gênero feminino, raça negra e, dentre os fatores do procedimento, tempo de isquemia fria do órgão maior que dez horas 14,15,17,27,28,29,30 .…”

Section: Introductionunclassified

Fatores de risco para a falência do transplante ortotópico de fígado no Rio Grande do Sul, Brasil

2007

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Fatores de risco para falência do transplante ortotópico de fígado com doador cadáver foram investigados em estudo longitudinal retrospectivo com informações da Central Estadual de Transplantes e prontuário clínico de residentes no Rio Grande do Sul, Brasil, submetidos, após os 15 anos de idade, pela primeira vez, a esse transplante de janeiro de 1999 a julho de 2003 (n = 313). Houve 13% de falências (n = 41) no primeiro mês, 11% (n = 34) de 2 a 12 meses e 5% (n = 17) após esse período; 88% das falências resultaram em óbito, 12%, em retransplante. Nos modelos multivariados, a taxa de falência foi maior para renda familiar menor que dez salários-mínimos, idade maior que 45 anos, cor não branca, mau estado geral à época do transplante e doador com 56 anos ou mais. Gênero feminino evidenciou efeito apenas no modelo bruto, perdendo o efeito no modelo multivariado. Apoio social, com complementação de renda e pronto diagnóstico com ingresso na lista em boas condições clínicas, pode favorecer o sucesso do transplante hepático.

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“…In these studies renal function is often recognized as a major determinant of patient survival after OLT (4). Other factors including diabetes mellitus, heart disease, underlying etiology of liver disease and gender have also been shown to influence survival after OLT (5)(6)(7)(8)(9). As the MELD score is heavily weighted in favor of patients with renal dysfunction, there is concern that allocation of organs based on the MELD score will adversely affect long-term outcome after liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

MELD and Other Factors Associated with Survival after Liver Transplantation

Menon¹,

Nyberg²,

Harmsen³

et al. 2004

American Journal of Transplantation

319

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Allocation of cadaveric livers for transplantation in the UnitedStates is now based on the severity of illness as determined by the model for end-stage liver disease (MELD) score, a function of bilirubin, creatinine and international normalized ratio (INR). The aim of our study was to determine the association of various pre-transplant risk factors, including the MELD score, on patient survival after orthotopic liver transplantation (OLT). The medical records of 499 consecutive patients (233 female, 266 males, mean age 50.9 ± 10.6 years) undergoing cadaveric OLT at our institution between June 1990 and February 1998 were reviewed. In the 407 patients alive at the latest contact, follow-up was 4.7 years, with a minimum of 20 months (maximum of 9.4 years). Variables considered for analysis included MELD score, age, pre-transplant renal dysfunction requiring dialysis, Child-Pugh classification, underlying liver disease, diabetes mellitus, and heart disease (ischemic/valvular/other). There were 92 deaths during follow-up. In univariate analysis, the MELD score, renal failure requiring hemodialysis pre-OLT, age > 42 years, and underlying etiology of liver disease were significantly associated with death during long-term followup. In multivariate models, age, underlying etiology of liver disease and renal failure requiring hemodialysis were independent predictors of death after OLT.

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Influence of donor and recipient gender on the outcome of liver transplantation

Cited by 47 publications

References 3 publications

The Effect of Donor Gender on Graft Survival

The Effect of Donor Gender on Graft Survival

Fatores de risco para a falência do transplante ortotópico de fígado no Rio Grande do Sul, Brasil

MELD and Other Factors Associated with Survival after Liver Transplantation

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