Zeier Martin, Döhler Bernd, Opelz Gerhard, Ritz Eberhard
Department of Internal Medicine/Nephrology, University of Heidelberg, Heidelberg, Germany.
J Am Soc Nephrol. 2002 Oct;13(10):2570-6. doi: 10.1097/01.asn.0000030078.74889.69.
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.
肾移植、心脏移植和肝移植中，已报道了供体性别对移植器官精算生存率的影响，但对于心脏和肝移植，相关研究样本量小，生物统计学效力有限。本研究利用协作移植研究（CTS）的大型数据库，评估了肾移植（n = 124,911）、心脏移植（n = 25,432）和肝移植（n = 16,410）中供体和受体性别对移植器官生存率的影响。研究考虑了混杂因素，如历年、地理区域、种族、供体和受体年龄、HLA错配、冷缺血时间等，以及交互项。与男性供体相比，女性供体的肾移植受者中，女性受者的死亡截尾精算肾移植生存率更低，男性受者更低。女性受者中，供体性别与移植器官丢失相关的风险比为1.15，男性受者为1.22。年龄-性别交互项具有统计学意义，与年长（>45岁）供体相比，年轻（16至45岁）供体的性别效应更明显。无论受体性别如何，接受来自女性供体肾移植的受者在移植后1年的血清肌酐浓度也更高。对于首次心脏移植，当供体为女性而受体为男性时，移植器官生存率较低，但在女性受者中，未发现供体性别有统计学差异。对于首次肝移植总体而言，未发现供体性别有显著差异。与接受男性供体肾移植的男性受者相比，接受女性供体肾移植的男性受者在第一年因排斥反应接受治疗的比例更高。在女性受者中，未发现供体性别有差异。对于心脏和肝移植，未发现供体性别对因排斥反应接受治疗的患者比例有显著影响。数据表明，女性供体性别对不同器官的不良影响远不如过去报道的那样一致。一个重要的混杂因素是供体年龄。心脏移植中也观察到性别对移植器官生存率的影响。因此，除了潜在的“肾单位剂量不足”外，必然还有其他病理机制起作用，可能是供体性别导致的免疫原性差异。
