The Role of Donor Sex in Females Undergoing Repeat Kidney Transplant: Does Prior Donor Sex Matter?

Abstract

F or individuals living with end-stage kidney disease (ESKD), kidney transplantation is the best treatment option for eligible patients, offering significant improvement in survival as well as quality of life versus remaining on dialysis. 1,2 Graft loss after kidney transplantation has devastating consequences, leading to increased morbidity, mortality, and reduced quality of life. 3 Donor-specific antibodies against HLAs have been shown to have adverse effects on transplant survival because of a well-established risk of antibody-mediated transplant rejection. 4 Routine pretransplant screening for donor-specific anti-HLA antibodies has led to improved kidney transplant outcomes over time 5 by informing the assignment of donor organs to recipients who lack HLA-incompatible antibodies or by identifying recipients who would benefit from desensitization protocols. 6 Given the known role of HLA mismatch (MM) in kidney transplant outcomes, many deceased donor kidney allocation protocols optimize HLA match between donors and recipients, with organs preferentially allocated to patients with a 0 HLA MM. 7 However, there is evidence to suggest that non-HLA minor histocompatibility antigens may also play an important role in transplant rejection. [8][9][10][11] Despite this, the potential impact of non-HLA antibodies on posttransplant outcomes is rarely, if ever, considered.Earlier studies have demonstrated a higher risk of graft loss in female recipients transplanted with male donor organs. [12][13][14][15]