Korean J Transplant.  2023 Nov;37(Suppl 1):S281. 10.4285/ATW2023.F-8934.

Impact of donor-recipient gender on the outcome of liver transplantation: a real world evidence study

• Gao F
• Dong L
• Wang K
• Xu X

• KMID: 2551910
• DOI: http://doi.org/10.4285/ATW2023.F-8934

Abstract

Background
The disparities based on gender were observed in liver transplantation (LT), but the impact of donor-recipient gender on the outcomes of LT remains elusive.
Methods
The clinicopathologic data of patients undergoing LT from February, 2002 to June, 2022 in the United Network for Organ Sharing (UNOS) national database were collected. The study population were divided into four groups according to donor-recipient gender. Propensity score matching (PSM) analysis was used to minimize between-group imbalances. The graft survival (GS) between the four groups was compared. Recipient variables that amplified the impact of female-male donor-recipient LT on GS were identified via interaction analysis.
Results
A total of 107,183 eligible recipients were finally included in this study according to the screening criteria. Of these recipients, 35,703 (33.3%) were women, and the median age was 56 years (inter quartile range, 49–62 years). After PSM, the 1-, 3- and 5-year GS of recipients in female-male donor-recipient group were significantly reduced when compared with male-female, male-male and female-female donor-recipient groups (P<0.001). Recipients in the female-female donor-recipient group have the best prognosis, with a 5-year survival rate up to 76.3%, significantly higher than other groups (P<0.001). There was significant interaction between the GS of recipients in female-male donor-recipient group with age 60 years (hazard ratio [HR], 1.005; P=0.023), autoimmune liver disease (HR, 1.202; P=0.020) and other liver disease (HR, 1.211; P=0.003). We classified recipients without these factors (age< 60 years and alcoholic liver disease or nonalcoholic fatty liver disease or viral hepatitis) as preferred cohort, in which GS of recipients in female-male donor-recipient group was no worse than other three groups after adjustment (P> 0.05).
Conclusions
Women could overcome the problem of allocation inequity with access to female donor livers preferentially with excellent prognosis. The risks of recipients in female-male donor-recipient group could be minimized by appropriate recipient selection.