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Gender medicine in corneal transplantation: influence of sex mismatch on rejection episodes and graft survival in a prospective cohort of patients

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Abstract

To evaluate the effect of donor-to-recipient sex mismatched (male donor corneas to female recipients) on the incidence of rejection episodes and failures up to 1 year after corneal transplantation. Prospective observational cohort study, with donor corneas randomly assigned and surgeons blind to the sex of donor. A unique eye bank retrieved and selected the donor corneas transplanted in 4 ophthalmic units in patients with clinical indication for primary or repeated keratoplasty for optical reasons, perforating or lamellar, either anterior or posterior. Rejection episode defined as any reversible or irreversible endothelial, epithelial or stromal sign, with or without development of corneal edema, and graft failure as a permanently cloudy graft or a regraft for any reason detected or acknowledged during a postoperative ophthalmic visit at any time up to 1 year after surgery were recorded.156 (28.6%) patients resulted donor-to-recipient gender mismatched for H-Y antigen (male donor to female recipient). During the 12 months follow-up, 83 (14.7%, 95% CI 12.0–17.9) grafts showed at least 1 rejection episode and 17 (3.2%, 95% CI 2.0–5.0) failed after immune rejection, among 54 (9.6%, 95% CI 7.4–12.3) grafts failed for all causes. No significant differences between matched and mismatched patients were found for cumulative incidence of both rejection episodes (15.2% and 13.5%) and graft failures following rejection (3.2% and 2.6%), respectively. Multivariable analyses showed that H-Y matching either is not a predictive factor for rejection or graft failure nor seems to influence incidence of failures on respect to patient’s risk category. The lack of influence of donor-to-recipient mismatched on the rate of rejections and graft failures resulting from this study do not support the adoption of donor-recipient matching in the allocation of corneas for transplantation.

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Acknowledgements

The authors would like to thank Marianna Berton, MD, for the assistance in funding this project and for general encouragement and helpful hints along the way.

Funding

This research received an unconditional restricted funding by AMMI (Associazione Mogli Medici Italiani, The Italian Medical Doctors’ Partners Association) in the framework of the VII Call for Gender Medicine and Pharmacology Application—year 2018.

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Authors and Affiliations

Authors

Contributions

AF: research design, participated in data analyses, writing of the paper. PG: data collection, database cleaning, manuscript revision. ACF: data analyses, manuscript revision. FB: surgery, patient evaluation and data collection. CM: surgery, patient evaluation and data collection. ER: surgery, patient evaluation and data collection. TB: patient evaluation and data collection. EP: surgery, patient evaluation and data collection. CM: patient evaluation and data collection. PV: surgery, patient evaluation and data collection. DP: manuscript revision. AF: research design, surgery, patient evaluation and data collection, final approval.

Corresponding author

Correspondence to Adriano Fasolo.

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The authors declare no conflict of interest.

Ethics approval

It was obtained for the conduction of the study by the Ethic Committee.

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It was obtained from all the patients.

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It was obtained from all the patients.

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Fasolo, A., Gallon, P., Frigo, A.C. et al. Gender medicine in corneal transplantation: influence of sex mismatch on rejection episodes and graft survival in a prospective cohort of patients. Cell Tissue Bank 22, 47–56 (2021). https://doi.org/10.1007/s10561-020-09864-x

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  • DOI: https://doi.org/10.1007/s10561-020-09864-x

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