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. 2012 Oct;9(5):335-347.e2.
doi: 10.1016/j.genm.2012.07.004. Epub 2012 Aug 18.

Donor-recipient sex mismatch in kidney transplantation

Jane C Tan  1 , Jane P Kim, Glenn M Chertow, F Carl Grumet, Manisha Desai
Affiliations

Donor-recipient sex mismatch in kidney transplantation

Jane C Tan et al. Gend Med. 2012 Oct.

Abstract

Background: The lack of reliable human proxies for minor (ie, non-HLA) histocompatibility loci hampers the ability to leverage these factors toward improving transplant outcomes. Despite conflicting reports of the effect of donor-recipient sex mismatch on renal allografts, the association between acute rejection of renal allografts and the development of human alloantibodies to the male H-Y antigen suggested to us that donor-recipient sex mismatch deserved re-evaluation.

Objective: To evaluate whether the relationships between donor sex and allograft failure differed by recipient sex.

Methods: We studied recipients of deceased-donor (n = 125,369) and living-donor (n = 63,139) transplants in the United States Renal Data System. Using Cox proportional hazards models stratified by donor type, we estimated the association between donor-recipient sex mismatch and death-censored allograft failure with adjustment for known risk factors, with and without the use of multiple imputation methods to account for potential bias and/or loss of efficiency due to missing data.

Results: The advantage afforded by male donor kidneys was more pronounced among male than among female recipients (8% vs 2% relative risk reduction; interaction P < 0.01). This difference is of the order of magnitude of several other risk factors affecting donor selection decisions.

Conclusions: Donor-recipient sex mismatch affects renal allograft survival in a direction consistent with immune responses to sexually determined minor histocompatibility antigens. Our study provides a paradigm for clinical detection of markers for minor histocompatibility loci.

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Conflict of interest statement

Disclosure

The Authors do not have any conflicts of interest to report.

Figures

Figure 1
Figure 1
The stepwise approach of the excluded population is detailed in this diagram. The analytic cohorts of the four models used in this study are delineated.
Figure 2
Figure 2
Kaplan Meier curves of death-censored (upper panels) and non-death-censored (lower panels) allograft failure for donor-recipient sex among deceased (left) and living (right) donors.
See this image and copyright information in PMC

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