Influence of donor-recipient gender mismatch on graft function and survival following lung transplantation

Abstract

Objectives: In current practice, donors and recipients are not matched for gender in lung transplantation. However, some data have suggested a possible effect of gender combinations on lung transplant outcomes. We examined whether donor-recipient (D/R) gender mismatch is related to adverse outcomes after lung transplantation in terms of early and long-term graft function and survival.

Methods: We reviewed 256 donors and lung transplant recipients over a 14-year period. Patients were distributed into four groups: Group A (D/R: female/female), Group B (D/R: male/male), Group C (D/R: female/male), Group D (D/R: male/female). Donor and recipient variables were compared among groups, including early graft function, 30-day mortality, freedom from bronchiolitis obliterans syndrome (BOS), and long-term survival.

Results: Group A: 57 (22%), Group B: 99 (39%), Group C: 62 (24%), Group D: 38 (15%) transplants (P = 0.001). Donor age was 29 ± 14, 27 ± 12, 33 ± 13 and 23 ± 12 years for Groups A, B, C and D, respectively (P = 0.004). Recipient age was 31 ± 15, 44 ± 17, 42 ± 16 and 30 ± 16 years for Groups A, B, C and D, respectively (P = 0.000). PaO2/FiO2 (mmHg) 24 h post-transplant was: Group A: 276 ± 144, Group B: 297 ± 131, Group C: 344 ± 133 and Group D: 238 ± 138 (P = 0.015). Primary graft dysfunction developed in 23, 14, 17 and 21% of recipients from Groups A, B, C and D, respectively (P = 0.45). Operative mortality was 4.4, 6.5, 5.2 and 2%, for recipients from Groups A, B, C and D, respectively (P = 0.66). Freedom from BOS was 73, 59 and 36% for gender-matched transplants vs 76, 67 and 40% for gender-mismatched transplants at 3, 5 and 10 years, respectively (P = 0.618), without differences among groups. A non-significant survival benefit was observed for female recipients, irrespective of the donor gender.

Conclusions: Donor-recipient gender mismatch does not have a negative impact on early graft function and mortality following lung transplantation. There is a trend towards a survival benefit for female recipients, irrespective of the donor gender.

Figure 1:

(A) Probability of freedom from BOS in the overall series. (B) Probability of freedom from BOS between gender-matched and gender-mismatched lung transplants. (C) Probability of freedom from BOS according to donor and recipient gender combinations. FF: female-to-female; MM: male-to-male; FM: female-to-male; MF: male-to-female (Kaplan–Meier and log-rank test).

Figure 2:

Probability of freedom from BOS, according to donor and recipient gender combinations, and stratified by transplant indication (P = 0.534). A: COPD; B: Cystic fibrosis; C: Pulmonary fibrosis FF: female-to-female; MM: male-to-male; FM: female-to-male; MF: male-to-female (Kaplan–Meier and log-rank test).

Figure 3:

(A) Probability of survival comparing recipient gender. (B) Probability of survival comparing gender-matched and gender-mismatched lung transplants. (C) Comparative survival according to donor and recipient gender combinations. (D) Probability of survival by transplant indication. FF: female-to-female; MM: male-to-male; FM: female-to-male; MF: male-to-female; COPD: chronic obstructive pulmonary disease; CF: cystic fibrosis; IPF: idiopathic pulmonary fibrosis (Kaplan–Meier and log-rank test).

Figure 4:

(A) Probability of survival, conditional to 1-year survival, according to recipient gender. (B) Probability of survival, conditional to 1-year survival, comparing gender-matched and gender-mismatched lung transplants. (C) Comparative survival, conditional to 1-year survival, according to donor and recipient gender combinations. (D) Probability of survival, conditional to 1-year survival, according to transplant indication. FF: female-to-female; MM: male-to-male; FM: female-to-male; MF: male-to-female; COPD: chronic obstructive pulmonary disease; CF: cystic fibrosis; IPF: idiopathic pulmonary fibrosis (Kaplan–Meier and log-rank test).