Donor-recipient sex mismatch in kidney transplantation.
Gend Med
; 9(5): 335-347.e2, 2012 Oct.
Article
in En
| MEDLINE
| ID: mdl-22906727
ABSTRACT
BACKGROUND:
The lack of reliable human proxies for minor (ie, non-HLA) histocompatibility loci hampers the ability to leverage these factors toward improving transplant outcomes. Despite conflicting reports of the effect of donor-recipient sex mismatch on renal allografts, the association between acute rejection of renal allografts and the development of human alloantibodies to the male H-Y antigen suggested to us that donor-recipient sex mismatch deserved re-evaluation.OBJECTIVE:
To evaluate whether the relationships between donor sex and allograft failure differed by recipient sex.METHODS:
We studied recipients of deceased-donor (n = 125,369) and living-donor (n = 63,139) transplants in the United States Renal Data System. Using Cox proportional hazards models stratified by donor type, we estimated the association between donor-recipient sex mismatch and death-censored allograft failure with adjustment for known risk factors, with and without the use of multiple imputation methods to account for potential bias and/or loss of efficiency due to missing data.RESULTS:
The advantage afforded by male donor kidneys was more pronounced among male than among female recipients (8% vs 2% relative risk reduction; interaction P < 0.01). This difference is of the order of magnitude of several other risk factors affecting donor selection decisions.CONCLUSIONS:
Donor-recipient sex mismatch affects renal allograft survival in a direction consistent with immune responses to sexually determined minor histocompatibility antigens. Our study provides a paradigm for clinical detection of markers for minor histocompatibility loci.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
H-Y Antigen
/
Kidney Transplantation
/
Graft Rejection
/
Graft Survival
/
Histocompatibility
Type of study:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
Gend Med
Journal subject:
MEDICINA
/
SAUDE DA MULHER
Year:
2012
Document type:
Article
Affiliation country: