Department of Surgery and Multidisciplinary Treatment, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Transplantation. 2012 Jan 15;93(1):93-8. doi: 10.1097/TP.0b013e318238dacd.
Female liver to male recipient is a well-accepted risk factor for graft loss in cadaveric liver transplantation. However, gender matching is infeasible because of an insufficient number of available donors. No studies have been performed on the role of gender in the field of living donor liver transplantation. This report investigates the effect of gender mismatch on the outcome of living donor liver transplantation.
A total of 335 patients and donors were classified into four groups according to the following gender combinations: male donor to male recipient group (n=104), male donor to female recipient group (n=120), female donor to male recipient (FM) group (n=59), and female donor to female recipient group (n=52). Patient and graft survival were compared among the groups. We performed a multivariable analysis to identify the factors associated with patient mortality.
The 1-, 3-, 5-, and 10-year patient survival rates in the FM group were 80.6%, 66.8%, 61.8%, and 47.7%, respectively. The FM group showed significantly shorter patient survival compared with the other three groups. Independent risk factors for patient mortality were: FM group (P=0.006), pretransplant diabetes mellitus (P=0.001), and a model for end-stage liver disease score more than or equal to 20 (P=0.004).
Male recipients of transplants from female donors, pretransplant diabetes mellitus, and a model for end-stage liver disease score more than or equal to 20 have poor survival rates.
女性供肝给男性受者是尸体肝移植中导致移植物丢失的一个公认的危险因素。然而，由于可供移植的供体数量不足，性别匹配是不可行的。在活体肝移植领域，尚未有研究探讨性别因素的作用。本报告旨在研究性别不匹配对活体肝移植结局的影响。
根据以下性别组合，将 335 例患者和供者分为四组：男性供者-男性受者组（n=104）、男性供者-女性受者组（n=120）、女性供者-男性受者组（FM 组，n=59）和女性供者-女性受者组（n=52）。比较各组患者和移植物的存活率。我们进行了多变量分析，以确定与患者死亡率相关的因素。
FM 组患者的 1、3、5 和 10 年存活率分别为 80.6%、66.8%、61.8%和 47.7%。FM 组患者的存活率明显短于其他三组。患者死亡的独立危险因素是：FM 组（P=0.006）、移植前糖尿病（P=0.001）和终末期肝病模型评分≥20（P=0.004）。
接受女性供者肝脏移植的男性受者、移植前糖尿病和终末期肝病模型评分≥20 的患者生存率较低。
