Influence of Donor and Recipient Gender Mismatch on the Outcomes of Living Donor Liver Transplantation in a Sector of Egyptian Population: A Single Center Study

Abstract

Introduction: The influence of donor-recipient gender mismatch on outcomes after liver transplantation is controversial, in spite of the extensive literature on renal transplantation showing inferior results with female donors. The aim of our study was to evaluate the effect of donor and recipient gender mismatch on the outcomes of living donor liver transplantation (LDLT), especially graft and patient survival, in a sector of Egyptian population. Methods: 125 Egyptian, >18 years old LDLT recipients were included in this retrospective cohort study. Patients were categorized based on gender and compared in light of donor, recipient and postoperative variables. Patient and graft survival curves were generated using Kaplan-Meier method and compared by log-rank test. Multivariate cox regression was used to calculate hazard ratio in a model that included significant variables. The study protocol was accepted by the faculty ethical committee. No donor organs were obtained from executed prisoners or other institutionalized persons. Results: No significant difference was found between different groups regarding post LDLT causes of graft failure or patient death, infections, rejections, vascular or biliary complications. Despite the lack of statistical significance, a trend of poorer overall graft and patient survival was found among the female recipients regardless of donor gender (P = 0.137, 0.263. respectively), recipients of a donor-recipient gender mismatch livers when compared to recipients of gender match livers (P = 0.370, 0.653, respectively), and particularly, Male to Female gender combination was found to have the worst graft and patient survival (P = 0.439, 0.121, respectively). After adjustment of significant variable, multivariate cox regression analysis, showed that female recipients regardless of donor's gender (HR= 2.07, 95% CI 0.79-5.51; P = 0.15), recipients of gender mismatch liver (HR= 1.30, 95% CI 0.63-2.69; P = 0.48) and female recipients of male liver (HR= 2.69, 95% CI 0.90-8.10; P = 0.08) may be at higher risk of graft failure but with lack of statistical significance Conclusion: We believe despite of statistical insignificance that gender mismatch between donor and recipient may affect patient and graft survival after LDLT and that our results may affect the selection of donor organs, especially in LDLT when more than one suitable donor is present but larger and more focused studies, especially in LDLT recipients, are needed to investigate more these findings880_A Figure 1. Kaplan-Meier estimate of graft survival of LDLT recipients in Main groups880_B Figure 2. Kaplan-Meier estimate of graft survival after LDLT by recipient gender880_C Figure 3 No Caption available.