Does gender affect renal transplant outcomes?
Patel A, and Prashar R. Does gender affect renal transplant outcomes? Am J Transplant 2017; 17:631-632.
Am J Transplant
Many studies have evaluated the role of gender on renal transplantation.Females (F) are less likely than males (M) to be on the waitlist (WL); less likely to receive a deceased or living donor transplant. There is meager data about post-transplant outcomes in this patient population. The aim of our study was to analyze the effect of gender on patient and graft outcomes in renal transplant recipients (RTR). METHODS: We identified patients in the United Network of Organ Sharing database between January 2006 and June 2016, who were recipients of first kidney transplant. Cox regression modelling was used to identify factors associated with patient death and death censored allograft failure (DCGF) in male and female R with all available data variables. Median follow up was 4 years. RESULTS: Of the 365,608 patients on the WL, 39% were F, 61 % were M; 32% of F were listed preemptively compared to 28.5% of M (p<0.001). Death on the WL was significantly lower in F, as was delisting from deteriorating medical condition. There was a longer WL time. Of the 69,335 included in the regression modeling, after controlling for several data variables, F appeared to have better survival than M (Hazard ratio-HR: 0.89) (Table presented). There were no differences in DCGF, GF from acute rejection, chronic rejection, infection, recurrent disease or primary non function. In both genders, at varying HRs, significant risk factors for death were non-black race, older R age, dialysis vintage, OPO WT, R comorbidity score, higher KDPI and cPRA and delayed graft function. In both groups, risk factors for DCGF were similar at varying HRs. In Summary: Despite a longer wait time, F RTR appeared to have a significantly better patient survival and no difference in DCGF compared to M. The possibility of better health maintenance, differential effect of sex hormones, immunological differences and innate biological tendency remains to be studied. Male mortality could be from the higher comorbidity index stemming from the greater incidence of heart disease and hypertension. We are analyzing effect of socioeconomic factors, behavioral tendencies and compliance on post-transplant survival.