Abstract
This study evaluated the combined effect of recipient-to-donor weight and sex mismatch after deceased-donor renal transplantation in a German transplant cohort and the evolution of recipient-to-donor weight difference over a 13-year observation period. The association of absolute weight and sex difference with graft failure was explored in an outpatient cohort of deceased-donor transplant recipients who underwent kidney transplantation between 2000 and 2012. Graft failure was defined as repeated need for dialysis or death with a functioning graft. Recipient and donor sex pairings were classified as sex concordant (MDMR/FDFR) or discordant (MDFR/FDMR). These classes were further stratified into four groups according to recipient-to-donor weight mismatch ≥10 kg (recipient > donor) or <10 kg (recipient < donor). Multivariable Cox proportional hazards models were applied to evaluate the time to graft loss adjusting for donor, immunologic, surgical, organizational, and recipient predictors. Sex-concordant transplant pairings <10 kg weight difference served as the reference group. Among 826 transplant recipients, 154 developed graft failure (18.6%). Median graft survival time was 3.9 years; first quartile (0.2–1.2), second quartile (1.2–2.9), third quartile (2.9–5.8), and fourth quartile (5.8–12.4). After multivariable adjustment, the highest relative hazard for graft failure was observed for sex-discordant transplant pairings with a ≥10 kg weight difference between recipient and donor (compared to the reference group MDMR/FDFR with weight difference <10 kg, MDMR/FDFR with weight difference ≥10 kg, hazard ratio 1.86, 95% confidence interval 1.07–3.32—p = 0.029; MDFR/FDMR with weight difference <10 kg, hazard ratio 1.14, 95% confidence interval 0.78–1.68—p = 0.507, and MDFR/FDMR with weight difference ≥10 kg, hazard ratio 2.00, 95% confidence interval 1.15–3.48—p = 0.014). A recipient-to-donor weight mismatch of ≥10 kg was associated with an increased risk of graft loss or recipient death with a functioning graft. Concurrent sex discordance seemed to enhance this effect as indicated by an increase in the hazard ratio. We detected no significant tendency for increasing recipient-to-donor weight differences from 2000 to 2012.
Highlights
Renal transplantation has become the primary option for the treatment of end-stage renal disease in many countries
Kidney transplant recipients of organs from deceased donors have benefitted from improvements in survival rates and quality of life compared with end-stage renal disease patients on dialysis [1]
Applying a different analytical approach, the combined effect of size and sex mismatch has been explored in a large cohort of deceased-donor transplant recipients using the United States Scientific Registry of Transplant Recipients (SRTR), indicating a higher graft failure rate in cases of concurrent mismatch in donor-recipient weight and sex [12]
Summary
Renal transplantation has become the primary option for the treatment of end-stage renal disease in many countries. The worse outcome seen in female grafts that have been transplanted to male recipients is generally attributed to a size mismatch with resultant nephron underdosing [10], whereas a general immunologic mismatch between the sexes has been assumed due to the minor histocompatibility antigen H-Y [11]. These investigations have analysed the effects of weight and sex mis-matches on graft survival as single mathematical variables. Applying the same analytical approach, we aimed at determining the additive effect of weight and sex mismatch after renal transplantation on long-term graft survival in a single center German cohort of deceased-donor transplant recipients. We investigated trends in recipient to donor weight differences over the study period of 13 years
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
