Giacomo Germani1, Nicola Zeni1, Alberto Zanetto1, René Adam2, Vincent Karam2, Luca S Belli3, John O'Grady4, Darius Mirza5, Jurgen Klempnauer6, Daniel Cherqui7, Johann Pratschke8, Neville Jamieson9, Mauro Salizzoni10, Ernest Hidalgo11, Jan Lerut12, Andreas Paul13, Juan Carlos Garcia-Valdecasas14, Fernando San Juan Rodríguez15, Erica Villa16, Patrizia Burra1. 1. Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy. 2. ELTR, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre Hepato-Biliaire, Universite´Paris-Sud, Villejuif, France. 3. Gastroenterology and Hepatology, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 4. King's College Hospital, London, UK. 5. The Queen Elizabeth Hospital, Birmingham, UK. 6. Medizinische Hochschule Hannover, Hannover, Germany. 7. Paul Brousse Hospital, Villejuif, France. 8. Charité - Campus - Virchow Klinikum, Berlin, Germany. 9. Addenbrooke's Hospital, Cambridge, UK. 10. Centro de Trapianti di Fegato, Torino, Italy. 11. St. Jame's & Seacroft University Hospital, Leeds, UK. 12. Universitè Catholique Louvain, Brussels, Belgium. 13. C.U.K. GHs Essen, Essen, Germany. 14. Hospital Clinic I Provincial de Barcelona, Barcelona, Spain. 15. Hospital Universitario LA FE, Valencia, Spain. 16. Department of Gastroenterology, Policlinico of Modena University Hospital of Modena, Modena, Italy.
Abstract
BACKGROUND & AIMS: The impact of gender and donor/recipient gender mismatch on LT outcomes is controversial. The aim of this study was to compare outcomes of LT in Europe, using the ELTR database, between male and female recipients, including donor/recipient gender mismatch. METHODS: Recipient, donor and transplant characteristics were compared between male and female patients. Patient survival was compared between groups, and the impact of donor/recipient gender matching as well as donor and recipient anthropometric characteristics were evaluated as potential risk factors for post-LT death/graft loss. RESULTS: A total of 46,334 LT patients were evaluated (70.5% men and 29.5% women). Ten-year survival rate was significantly higher in female than in male recipients (66% vs 59%, P < .0001). At multivariate analysis, adjusted for indication to LT and type of graft, donor/recipient gender mismatch (HR 1.12, 95% CI 1.04-1.2; P = .003), donor age > 60 years (HR 1.09, 95% CI 1.01-1.18; P = .027) and recipient age (HR 1.02, 95% CI 1.1-1.02; P < .0001) were significantly associated with post-LT lower survival rate in men. Conversely in female recipients, donor BMI > 30 (HR 1.32, 95% CI 1.09-1.6; P = .005), donor age > 60 years (HR 1.15, 95% CI 1.01-1.32; P = .027) and recipient age (HR 1.02, 95% CI 1.01-1.02; P < .0001) were significantly associated with lower post-LT survival rate. CONCLUSIONS: Donor/recipient gender mismatch in male recipients and the use of obese donor in female recipients are associated with reduced survival after LT. Therefore, the incorporation of donor and recipient anthropometric quantities in the allocation process should be a matter of further studies, as their matching can significantly influence long-term outcomes.
BACKGROUND & AIMS: The impact of gender and donor/recipient gender mismatch on LT outcomes is controversial. The aim of this study was to compare outcomes of LT in Europe, using the ELTR database, between male and female recipients, including donor/recipient gender mismatch. METHODS: Recipient, donor and transplant characteristics were compared between male and female patients. Patient survival was compared between groups, and the impact of donor/recipient gender matching as well as donor and recipient anthropometric characteristics were evaluated as potential risk factors for post-LT death/graft loss. RESULTS: A total of 46,334 LT patients were evaluated (70.5% men and 29.5% women). Ten-year survival rate was significantly higher in female than in male recipients (66% vs 59%, P < .0001). At multivariate analysis, adjusted for indication to LT and type of graft, donor/recipient gender mismatch (HR 1.12, 95% CI 1.04-1.2; P = .003), donor age > 60 years (HR 1.09, 95% CI 1.01-1.18; P = .027) and recipient age (HR 1.02, 95% CI 1.1-1.02; P < .0001) were significantly associated with post-LT lower survival rate in men. Conversely in female recipients, donor BMI > 30 (HR 1.32, 95% CI 1.09-1.6; P = .005), donor age > 60 years (HR 1.15, 95% CI 1.01-1.32; P = .027) and recipient age (HR 1.02, 95% CI 1.01-1.02; P < .0001) were significantly associated with lower post-LT survival rate. CONCLUSIONS: Donor/recipient gender mismatch in male recipients and the use of obese donor in female recipients are associated with reduced survival after LT. Therefore, the incorporation of donor and recipient anthropometric quantities in the allocation process should be a matter of further studies, as their matching can significantly influence long-term outcomes.
Authors: M Trinidad Serrano; Sergio Sabroso; Luis M Esteban; Marina Berenguer; Constantino Fondevila; Sara Lorente; Luis Cortés; Gloria Sanchez-Antolin; Javier Nuño; Gloria De la Rosa; Magdalena Salcedo Journal: Transpl Int Date: 2022-05-09 Impact factor: 3.842