The effect of donor gender on graft survival
The effect of donor gender on graft survival
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DOI：
10.1097/01.asn.0000030078.74889.69
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发表时间：
2002-10-01
影响因子：
13.6
通讯作者：
Ritz, E
中科院分区：
文献类型：
--
作者：
Zeier, M;Döhler, B;Ritz, E
肾移植和心脏和肝脏移植的精算移植物存活率根据供者性别的差异已有报道，但后者的存活率是小范围的，生物统计学能力有限。利用协作性移植研究(CTS)的大型数据库，本研究根据供受者性别评估肾移植(n=124,911)、心脏移植(n=25,432)和肝移植(n=16,410)的移植物存活率。混杂因素，如历年，地理地区，种族，供者和受者年龄，人类白细胞抗原不匹配，冷缺血时间，以及其他因素，以及相互作用条件都被考虑在内。与男性供者相比，女性受者的精算肾移植存活率在女性受者中较低，在男性受者中更低。供者性别相关的移植物丢失风险比女性为1.15，男性为1.22。年龄-性别交互作用的术语具有统计学意义，与年龄较大(45岁)的捐赠者相比，年龄较小(16岁至45岁)的捐赠者的性别影响更为明显。无论受者性别如何，接受女性供者肾移植的受者在移植后一年的血肌酐浓度也较高。对于首次心脏移植，当供者为女性和受者为男性时，移植物存活率较低，但在女性受者中，供者性别的差异没有统计学意义。总体上看，首次肝移植患者的供者性别没有显著差异。接受女性捐赠者肾脏的男性受者在第一年接受排斥危象治疗的比例高于男性捐赠者。在女性受者中，供者性别没有明显差异，对于心脏和肝脏移植，供者性别对因排斥反应而接受治疗的患者比例没有显著影响。数据显示，女性捐赠者的性别对不同器官的不利影响比过去报道的要少得多。一个重要的混淆因素是捐赠者的年龄。对于同种异体心脏移植物，也观察到性别对移植物存活的影响。因此，除了潜在的“肾单位剂量不足”，进一步的病理机制必须发挥作用，可能在免疫原性方面根据供者性别的不同而不同。
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 I 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.