Schoening Wenzel N, Helbig Michael, Buescher Niklas, Andreou Andreas, Bahra Marcus, Schmitz Volker, Pascher Andreas, Pratschke Johann, Seehofer Daniel
From the Department of General, Visceral, and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany; and the Department of General, Visceral, and Transplantation Surgery, University Hospital of RWTH, Aachen, Germany.
Exp Clin Transplant. 2016 Apr;14(2):184-90.
The influence of donor-recipient sex mismatches on long-term graft survival after liver transplant is controversial. In this study, our aim was to characterize the differences in long-term graft outcome after liver transplant in more than 2000 cases with special regard to sex match and mismatch.
In this retrospective, single center study of 2144 adult primary liver transplant recipients (median follow-up of 92 months), we analyzed specific long-term graft survival and the effect of different donor and recipient sex combinations (Kaplan-Meier, multivariate regression).
In the 15-year follow-up, female recipients (58.6%) had significantly better graft survival than male recipients did (51.6%, P = .031). Matched and mismatched male-female combinations revealed significant differences (P = .003): a male donor-female recipient combination showed the best 15-year graft survival (61.1%), and a female donor-male recipient combination showed the worst graft survival (48.6%), whereas male-male (53.3%) and female-female combinations (55.6%) were not significantly different (P = .967). Donor age (P ≤ .0001), body mass index (P = .021), female sex (P = .015), Eurotransplant Donor Risk Index > 1.4 (P ≤ .001), recipients' age (P < .0001), indication for liver transplant (P < .0001), and kidney function (P = .003) significantly affected graft survival. In the multivariate analysis model, a Eurotransplant Donor Risk Index > 1.4 and impaired kidney function at liver transplant again emerged as significant negative predictors. Female donors and male recipients showed significantly more unfavorable characteristics concerning long-term graft survival.
The impressive long-term graft survival benefit of male donor-female recipient versus female donor-male recipient and of male donor-female recipient versus matched groups (male-male, female-female) in liver transplant may be caused by significant differences in donor quality and recipient characteristics and may not be related to sex itself.
供体与受体性别不匹配对肝移植后长期移植物存活的影响存在争议。在本研究中，我们的目的是在2000多例病例中，特别关注性别匹配和不匹配情况，对肝移植后长期移植物结局的差异进行特征描述。
在这项对2144例成人原位肝移植受者的回顾性单中心研究（中位随访时间92个月）中，我们分析了特定的长期移植物存活情况以及不同供体与受体性别组合的影响（Kaplan-Meier法、多因素回归分析）。
在15年的随访中，女性受者（58.6%）的移植物存活情况显著优于男性受者（51.6%，P = 0.031）。男性与女性匹配和不匹配的组合显示出显著差异（P = 0.003）：男性供体-女性受体组合的15年移植物存活率最高（61.1%），女性供体-男性受体组合的移植物存活率最低（48.6%），而男性-男性组合（53.3%）和女性-女性组合（55.6%）无显著差异（P = 0.967）。供体年龄（P≤0.0001）、体重指数（P = 0.021）、女性性别（P = 0.015）、欧洲移植供体风险指数>1.4（P≤0.001）、受者年龄（P<0.0001）、肝移植指征（P<0.0001）和肾功能（P = 0.003）显著影响移植物存活。在多因素分析模型中，欧洲移植供体风险指数>1.4和肝移植时肾功能受损再次成为显著的负性预测因素。女性供体和男性受者在长期移植物存活方面表现出明显更不利的特征。
肝移植中男性供体-女性受体相对于女性供体-男性受体以及男性供体-女性受体相对于匹配组（男性-男性、女性-女性）在长期移植物存活方面的显著益处，可能是由于供体质量和受者特征的显著差异所致，可能与性别本身无关。
