The impact of recipient and donor gender-match and mismatch on the post-liver transplant outcomes of patients with primary biliary cholangitis

• Published in: Digestive and liver disease 2023-09, Vol.55 (9), p.1242-1252
• Main Authors: Lee, David Uihwan, Ponder, Reid, Sandlow, Sarah, Yoo, Ashley, Lee, Ki Jung, Chou, Harrison, Fan, Gregory Hongyuan, Urrunaga, Nathalie Helen
• Format: Article
• Language: English
• Subjects: Female; Gender disparity analysis; Gender Identity; Graft Survival; Humans; Liver Cirrhosis, Biliary - surgery; Liver Transplantation - adverse effects; Male; PBC; Post-LT prognosis; Prognosis; Recipient-donor-gender-mismatch; Retrospective Studies; Tissue Donors; Transplant Recipients; UNOS-STAR registry
• ISSN: 1590-8658; 1878-3562; 1878-3562
• DOI: 10.1016/j.dld.2023.03.018

In this study, we evaluate the effects of donor gender on post-liver transplant (LT) prognosis. We specifically consider patients with primary biliary cholangitis (PBC). The 2005 to 2019 UNOS transplant registry was used to select patients with PBC. The study cohort was stratified by donor gender. All-cause mortality and graft failure hazards were compared using iterative Cox regression analysis. Subanalyses were performed to evaluate gender mismatch on post-LT prognosis. There were 1885 patients with PBC. Of these cases, 965 entries had male donors and 920 had female donors. Median follow-up was 4.82 (25–75% IQR 1.83–8.93) years. Having a male donor was associated with higher all-cause mortality (aHR 1.28 95%CI 1.03–1.58) and graft failure (aHR 1.70 95%CI 1.02–2.82). Corresponding incidence rates were also relatively increased. In the sub-analysis of female recipients (n = 1581), those with gender-mismatch (male donors, n = 769) were associated with higher all-cause mortality (aHR 1.41 95%CI 1.11–1.78) but not graft failure. In the male recipient subanalysis (n = 304), no associations were found between gender-mismatch (female donors, n = 108) and all-cause mortality or graft failure. This study shows that recipients who have male donors experienced higher rates of all-cause mortality following LT. This finding was consistent in the female recipient-male donor mismatch cohort.