Influence of donor sex and age on graft outcome in kidney transplantation

Author:

Melk Anette1,Sugianto Rizky I1,Zhang Xun2,Dahhou Mourad2,Döhler Bernd3,Süsal Caner4,Sapir-Pichhadze Ruth256,Wong Germaine7ORCID,Foster Bethany J268

Affiliation:

1. Children's Hospital, Hannover Medical School , Hannover , Germany

2. Research Institute of the McGill University Health Centre , Centre for Outcomes Research and Evaluation, Montréal , QC, Canada

3. Institute of Immunology, Heidelberg University Hospital , Heidelberg , Germany

4. Transplant Immunology Research Center of Excellence, Koç University , Istanbul , Turkey

5. Department of Medicine, Division of Nephrology , McGill University, Montréal, QC , Canada

6. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University , Montréal , QC, Canada

7. School of Public Health, University of Sydney , Sydney, New South Wales , Australia

8. Department of Pediatrics, Division of Nephrology, McGill University , Montréal, QC , Canada

Abstract

ABSTRACT Background There is a known recipient sex–dependent association between donor sex and kidney transplant survival. We hypothesized that donor age also modifies the association between donor sex and graft survival. Methods First, deceased donor kidney transplant recipients (1988–2019, n = 461 364) recorded in the Scientific Registry of Transplant Recipients, the Australia and New Zealand Dialysis and Transplant Registry and the Collaborative Transplant Study were analyzed. We used multivariable Cox regression models to estimate the association between donor sex and death censored graft loss, accounting for the modifying effects of recipient sex and donor age; donor age was categorized as 5–19, 20–34, 35–49, 50–59 and ≥60 years. Results from cohort-specific Cox models were combined using individual patient data meta-analysis. Results Among female recipients of donors aged <60 years, graft loss hazards did not differ by donor sex; recipients of female donors ≥60 years showed significantly lower graft loss hazards than recipients of male donors of the same age [combined adjusted hazard ratio (aHR) 0.90, 95% CI 0.86–0.94]. Among male recipients, female donors aged <50 years were associated with significantly higher graft loss hazards than same-aged male donors (5–19 years: aHR 1.11, 95% CI 1.02–1.21; 20–34 years: aHR 1.08, 95% CI 1.02–1.15; 35–49 years: aHR 1.07, 95% CI 1.04–1.10). There were no significant differences in graft loss by donor sex among male recipients of donors aged ≥50 years. Conclusion Donor age modifies the association between donor sex and graft survival. Older female donors were associated with similar or lower hazards of graft failure than older male donors in both male and female recipients, suggesting a better functional reserve of older female donor kidneys.

Funder

Canadian Institutes of Health Research

Horizon 2020

Fonds de Recherche du Québec - Santé

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

Reference32 articles.

1. The effect of donor gender on graft survival;Zeier;J Am Soc Nephrol,2002

2. The influence of age, sex, race, and body habitus on kidney weight in humans;Kasiske;Arch Pathol Lab Med,1986

3. Ratio of donor kidney weight to recipient bodyweight as an index of graft function;Kim;Lancet North Am Ed,2001

4. Glomerular number and size in autopsy kidneys: the relationship to birth weight;Hughson;Kidney Int,2003

5. H-Y incompatibility predicts short-term outcomes for kidney transplant recipients;Kim;J Am Soc Nephrol,2009

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