Influence of donor and recipient gender on liver transplantation outcomes in Europe.
BACKGROUND & AIMS
The impact of gender and donor/recipient gender mismatch on LT outcomes is controversial. The aim of this study was to compare outcomes of LT in Europe, using the ELTR database, between male and female recipients, including donor/recipient gender mismatch.


METHODS
Recipient, donor and transplant characteristics were compared between male and female patients. Patient survival was compared between groups, and the impact of donor/recipient gender matching as well as donor and recipient anthropometric characteristics were evaluated as potential risk factors for post-LT death/graft loss.


RESULTS
A total of 46,334 LT patients were evaluated (70.5% men and 29.5% women). Ten-year survival rate was significantly higher in female than in male recipients (66% vs 59%, P < .0001). At multivariate analysis, adjusted for indication to LT and type of graft, donor/recipient gender mismatch (HR 1.12, 95% CI 1.04-1.2; P = .003), donor age > 60 years (HR 1.09, 95% CI 1.01-1.18; P = .027) and recipient age (HR 1.02, 95% CI 1.1-1.02; P < .0001) were significantly associated with post-LT lower survival rate in men. Conversely in female recipients, donor BMI > 30 (HR 1.32, 95% CI 1.09-1.6; P = .005), donor age > 60 years (HR 1.15, 95% CI 1.01-1.32; P = .027) and recipient age (HR 1.02, 95% CI 1.01-1.02; P < .0001) were significantly associated with lower post-LT survival rate.


CONCLUSIONS
Donor/recipient gender mismatch in male recipients and the use of obese donor in female recipients are associated with reduced survival after LT. Therefore, the incorporation of donor and recipient anthropometric quantities in the allocation process should be a matter of further studies, as their matching can significantly influence long-term outcomes.
['Germani|Giacomo|G|0000-0002-4332-2072', 'Zeni|Nicola|N|', 'Zanetto|Alberto|A|0000-0002-6734-7178', 'Adam|René|R|', 'Karam|Vincent|V|', 'Belli|Luca S|LS|0000-0001-8714-2439', "O'Grady|John|J|", 'Mirza|Darius|D|', 'Klempnauer|Jurgen|J|', 'Cherqui|Daniel|D|', 'Pratschke|Johann|J|', 'Jamieson|Neville|N|', 'Salizzoni|Mauro|M|', 'Hidalgo|Ernest|E|', 'Lerut|Jan|J|', 'Paul|Andreas|A|', 'Garcia-Valdecasas|Juan Carlos|JC|', 'Rodríguez|Fernando San Juan|FSJ|', 'Villa|Erica|E|', 'Burra|Patrizia|P|0000-0002-8791-191X', '|||']
D005060:Europe D005260:Female D006085:Graft Survival D006801:Humans D016031:Liver Transplantation D008297:Male D008875:Middle Aged D012189:Retrospective Studies D012307:Risk Factors D015996:Survival Rate D014019:Tissue Donors
donor recipient gender liver transplantation outcomes survival