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The impact of donor and recipient sex on kidney allograft survival in pediatric transplant recipients

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Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Transplantation is widely considered the gold standard method of kidney replacement therapy. Despite compelling evidence for biological sexual dimorphisms, the role of donor and recipient sex matching in transplantation is undefined.

Methods

The UK historical cohort study explores the impact of donor and recipient sex on allograft survival, in children receiving their first deceased donor transplant. Nationwide registry data were collected for 1316 transplant procedures performed from January 1, 1999, to December 31, 2019.

Results

Male donor–male recipient transplantation occurred most frequently (35%), followed by female donor–male recipient (23%), male donor–female recipient (22%), and female donor–female recipient (20%). The median follow-up time was 7.03 years (IQR: 2.89–12.4 years), with a total of 10,326 person-years. Male donor–male recipients were associated with the highest 10-year kidney allograft survival (72.8% [95% CI 68.3–77.8]) and male donor–female recipients with the lowest (64% [95% CI 57.7–71.1]). Multivariable Cox regression demonstrated for male donor transplantation, the risk of kidney allograft failure was 1.46 times greater for female (compared to male) recipients, after adjusting for acquired recipient age, recipient/donor age at transplantation, mismatched HLA A/B/DR, waitlist time, cold ischemia time, CMV seropositivity, donor hypertension, and donor diabetes (HR 1.46 [95% CI. 1.06–2.01], p = 0.02). There was no evidence for an independent effect of donor or recipient sex in other combinations.

Conclusion

This study highlights the complex relationship between donor and recipient sex and pediatric kidney allograft survival, which require further mechanistic evaluation.

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Data availability

All requests should be submitted to the corresponding author for consideration. Access to the anonymized data may be granted pending application review.

Abbreviations

CMV:

Cytomegalovirus

CI:

Confidence interval

CKD – V:

Chronic kidney disease stage five

eGFR:

Estimated glomerular filtration rate

HLA:

Human leukocyte antigens

HR:

Hazard ratio

IRR:

Incidence risk ratio

IQR:

Interquartile range

NHSBT:

National Health Service Blood and Transplant

SD:

Standard deviation

UK:

United Kingdom

USA:

United States of America

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Funding

This project was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. NM was funded by a National Institute of Health Research academic clinical fellowship.

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Authors and Affiliations

  1. NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK

    Nadeesha L Mudalige & Stephen D Marks

  2. National Health Service Blood and Transplant, Bristol, UK

    Chloe Brown

  3. Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK

    Stephen D Marks

Authors
  1. Nadeesha L Mudalige
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  2. Chloe Brown
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Correspondence to Nadeesha L Mudalige.

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Ethical approval was granted, following a written application which was made to the United Kingdom National Health Service Blood Service.

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Mudalige, N.L., Brown, C. & Marks, S.D. The impact of donor and recipient sex on kidney allograft survival in pediatric transplant recipients. Pediatr Nephrol 37, 209–216 (2022). https://doi.org/10.1007/s00467-021-05071-2

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  • DOI: https://doi.org/10.1007/s00467-021-05071-2

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