NEW YORK -- July 3, 2008 -- Female recipients of male donor kidneys have a higher rate of graft failure than other combinations of donor and recipient. Thus, consideration of sex should be integrated into future studies and decisions on organ allocation, according to a study published in the July 5 issue of The Lancet.
Alois Gratwohl, University Hospital Basel, Basel, Switzerland, and colleagues from the Collaborative Transplant Study, Heidelberg, Germany did a retrospective cohort study aiming to solve the discrepancy of donor and recipient gender issues in solid organ transplants.
The study included 195,516 recipients of deceased donors between 1985 and 2004, from over 400 centres in Europe. They used statistical methods capable of assessing multiple variables to compare graft survival and death-censored graft survival rates for female and male donor kidneys in female and male recipients at 1 and 10 years.
Researchers found that graft loss was more common with kidneys from female donors compared with those from male donors after both 1 and 10 years. Female recipients, by contrast, had a lower rate of graft failure between the end of the first year and the end of the tenth year.
Compared with all other combinations of sex, transplantation of male donor kidneys into female recipients was associated with an 8% increased risk of graft failure and an 11% increased risk of death-censored graft failure in the first year. Between years 2 and 10, the corresponding figures were 6% and 10%.
"Our multivariable analysis showed that transplantation of kidneys from male donor into female recipients caused an increased rate of graft failure, which suggests an immunological H-Y effect in renal transplantation during the first year after transplantation that extends to 10 years of follow-up," the authors wrote.
They elaborate that male recipients could probably profit from bigger male kidneys, with their higher number of nephrons. Female recipients, however, might not need the same number of nephrons as men, and could profit from the lower likelihood of rejection associated with a sex-matched donor kidney.
SOURCE: The Lancet
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