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Gend Med. 2012 Oct;9(5):335-347.e2. doi: 10.1016/j.genm.2012.07.004. Epub 2012 Aug 18.

Donor-recipient sex mismatch in kidney transplantation.

Author information

1
Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA. Jane.tan@stanford.edu

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.

PMID:
22906727
PMCID:
PMC3478108
DOI:
10.1016/j.genm.2012.07.004
[Indexed for MEDLINE]
Free PMC Article

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