Graňák Karol, Kováčiková Lea, Skálová Petra, Vnučák Matej, Miklušica Juraj, Laca Ľudovít, Mokáň Marián, Dedinská Ivana
Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia.
1st Department of Internal Diseases, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia.
Ann Transplant. 2020 Jul 17;25:e921117. doi: 10.12659/AOT.921117.
BACKGROUND The effect of a relative disproportion in the size of a transplanted kidney (KT) on graft function and survival is well documented. However, the importance of the H-Y antigen (male donor and female recipient) has not been unambiguously confirmed. MATERIAL AND METHODS Our retrospective analysis consists of 230 deceased donor/recipient pairs. The aim of the study was to determine the effect of sex mismatch between donors and recipients on the function of the graft and the graft and patient survival. RESULTS In the group of male donors, a statistically significantly lower value of the eGFR (estimated glomerular filtration rate) was recorded for female recipients in the fifth year after the KT (=0.0047). The male donor/female recipient group was an independent risk factor for: eGFR (<60 ml/min (CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration) in the third year after KT [HR 0.1618; (P=0.0004)], acute rejection in the first year after KT [HR 1.8992; (P=0.0387)], and the 5-year graft survival was significantly worse in this group. By adjusting the results for age and induction, this group was at significantly higher risk for decreased graft function (eGFR <30 ml/min) if the age of the donor was ≤50 years old and the recipient was >45 years old in the fifth year [HR 11.1676; (P=0.0139)], the age of the donor was ≤50 years old/recipient was ≤45 years old in the third year [HR 1.2500; (P=0.0050)], and also in the fifth year after KT [HR 8.1993; (P=0.0183)]. CONCLUSIONS Based on our analysis, the differences in the incidence of acute rejection episodes as well as in graft survival among the different groups of patients were confirmed. The group with the highest risk, in cases of an acute rejection episode, is a male donor/female recipient.
背景 移植肾（KT）大小相对不均衡对移植肾功能及存活的影响已有充分记录。然而，H-Y抗原（男性供体和女性受体）的重要性尚未得到明确证实。
材料与方法 我们的回顾性分析纳入了230对已故供体/受体配对。本研究的目的是确定供体与受体之间的性别不匹配对移植肾功能以及移植肾和患者存活的影响。
结果 在男性供体组中，肾移植术后第五年女性受体的估算肾小球滤过率（eGFR）值在统计学上显著更低（=0.0047）。男性供体/女性受体组是以下情况的独立危险因素：肾移植术后第三年eGFR<60 ml/min（CKD-EPI，慢性肾脏病流行病学协作组）[风险比（HR）0.1618；（P=0.0004）]，肾移植术后第一年急性排斥反应[HR 1.8992；（P=0.0387）]，且该组的5年移植肾存活率显著更低。通过对年龄和诱导治疗进行结果校正后，如果供体年龄≤50岁且受体在第五年>45岁[HR 11.1676；（P=0.0139）]，供体年龄≤50岁/受体≤45岁在第三年[HR 1.2500；（P=0.0050）]，以及肾移植术后第五年[HR 8.1993；（P=0.0183）]，该组移植肾功能下降（eGFR<30 ml/min）的风险显著更高。
结论 根据我们的分析，不同患者组之间急性排斥反应发生率以及移植肾存活的差异得到了证实。在发生急性排斥反应的情况下，风险最高的组是男性供体/女性受体。
