The role of donor sex on the post-liver transplant outcomes in patients with primary sclerosing cholangitis

Author:

Lee David Uihwan1,Harmacinski Ashton1,Kolachana Sindhura1,Bahadur Aneesh2,Lee KeeSeok2,Lee Ki Jung2,Pu Alex2,Chou Harrison2,Fan Gregory Hongyuan2,Malik Raza3

Affiliation:

1. Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland

2. Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston

3. Department of Transplantation and Hepatobiliary Diseases, Roger L Jenkins Transplant Institute, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA

Abstract

Background and aims: Primary sclerosing cholangitis (PSC) can result in hepatic decompensation and require liver transplantation (LT). This study investigates the effect of the sex of the donor and recipient as a prognostic risk factor for adverse outcomes after LT in patients with PSC. Methods: UNOS registry was used to select LT patients with PSC from 1987 to 2019. The study cohort was stratified based on the sex of the recipient and further subdivided based on the sex of the donor. The primary endpoints of this study were all-cause mortality and graft failure, which were evaluated using a sequential Cox regression analysis. Results: This study included 2829 patients; 906 female recipients were transplanted from 441 male donors and 465 female donors. 1923 male recipients were transplanted from 1194 male donors and 729 female donors. Within the mismatch analyses, the male-to-male recipients also had a significantly reduced hazard ratio of graft failure compared to female-to-male transplants [aHR 0.51, 95% confidence interval (CI) 0.33–0.79, P = 0.003]. No difference in graft failure was observed in the mismatched female recipient subgroup. The mismatched male recipient group also showed a decreased hazard ratio of mortality from graft rejection and respiratory causes. No differences in specific mortality causes were identified in the mismatched female recipient group. Conclusion: This study demonstrated an increase in the risk of graft failure and mortality secondary to graft failure in male recipients of female donor livers. No differences in mortality or graft failure were identified in female recipients of male livers.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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