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Coffman D, Jay CL, Sharda B, Garner M, Farney AC, Orlando G, Reeves-Daniel A, Mena-Gutierrez A, Sakhovskaya N, Stratta R, Stratta RJ. Influence of donor and recipient sex on outcomes following simultaneous pancreas-kidney transplantation in the new millennium: Single-center experience and review of the literature. Clin Transplant 2023; 37:e14864. [PMID: 36399473 PMCID: PMC10078322 DOI: 10.1111/ctr.14864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/28/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The influence of sex on outcomes following simultaneous pancreas-kidney transplantation (SPKT) in the modern era is uncertain. METHODS We retrospectively studied 255 patients undergoing SPKT from 11/2001 to 8/2020. Cases were stratified according to donor (D) sex, recipient (R) sex, 4 D/R sex categories, and D/R sex-matched versus mismatched. RESULTS D-male was associated with slightly higher patient (p = .08) and kidney (p = .002) but not pancreas (p = .23) graft survival rates (GSR) compared to D-female. There were no differences in recipient outcomes other than slightly higher pancreas thrombosis (8% R-female vs. 4.2% R-male, p = .28) and early relaparotomy rates in female recipients (38% R-female vs. 29% R-male, p = .14). When analyzing the 4 D/R sex categories, the two D-male groups had higher kidney GSRs compared to the two D-female groups (p = .01) whereas early relaparotomy and pancreas thrombosis rates were numerically higher in the D-female/R-female group compared to the other three groups. Finally, there were no significant differences in outcomes between sex-matched and sex-mismatched groups although overall survival outcomes were lower with female donors irrespective of recipient sex. CONCLUSIONS The influence of D/R sex following SPKT is subject to multiple confounding issues but survival rates appear to be higher in D-male/R-male and lower in D-female/R-male categories.
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Affiliation(s)
- David Coffman
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Colleen L Jay
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Berjesh Sharda
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Matthew Garner
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Alan C Farney
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Giuseppe Orlando
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Amber Reeves-Daniel
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Alejandra Mena-Gutierrez
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Natalia Sakhovskaya
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Robert Stratta
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Robert J Stratta
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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Sánchez Hidalgo JM, Durán Martínez M, Calleja Lozano R, Arjona Sánchez Á, Ayllón Terán MD, Rodríguez Ortiz L, Campos Hernández P, Rodríguez Benot A, Briceño Delgado FJ. Influence of Donor and Recipient Sex Matching in Simultaneous Pancreas-Kidney Transplantation Outcomes. Transplant Proc 2021; 53:2688-2691. [PMID: 34674881 DOI: 10.1016/j.transproceed.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies in solid organ transplantation have shown a correlation between donor and recipient sex mismatch and risk of graft loss; however, it is possible influence is not well established. The aim of our study was to review the outcomes of pancreatic and kidney grafts in our series depending on sex matching. METHODS We retrospectively analyzed a cohort of 199 patients who underwent simultaneous pancreas-kidney transplantation from February 1989 to June 2019 at the Reina Sofia University Hospital. RESULTS Survival of patients in the series was 93.5% at 5 years, 84.3% at 10 years, and 71.5% at 15 years. In the sex-discordant group, survival of patients in the series at 5, 10, and 15 years was 94%, 82.3%, and 71.7% compared with 92.3%, 85.1%, and 72.2% in the concordant group, with no statistically significant differences (P = .86). Pancreatic graft survival censored for death at 5, 10, and 15 years was 79.5%, 60.8%, and 57.5% in the group with discordant sex vs 77.5%, 67.8%, and 65.5% in the concordant group, finding no statistically significant differences (P = .54). Kidney graft survival censored for death at 5, 10, and 15 years was 89.3%, 85%, and 78.1% in the sex-discordant group vs 87.3%, 83.5%. and 78.8% in the concordant group, with no differences (P = .69). No differences were observed between the 2 groups in the rate of serious postoperative complications or acute rejection. CONCLUSION Our study shows that donor-recipient sex mismatch in simultaneous pancreas-kidney transplantation does not negatively influence perioperative outcomes and survival of the patient and both grafts.
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Affiliation(s)
- Juan Manuel Sánchez Hidalgo
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GC18 Translational Research in Surgery of Solid Organ Transplantation - Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
| | - Manuel Durán Martínez
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GC18 Translational Research in Surgery of Solid Organ Transplantation - Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
| | - Rafael Calleja Lozano
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GC18 Translational Research in Surgery of Solid Organ Transplantation - Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain.
| | - Álvaro Arjona Sánchez
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery - Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
| | - María Dolores Ayllón Terán
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GC18 Translational Research in Surgery of Solid Organ Transplantation - Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
| | - Lidia Rodríguez Ortiz
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery - Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
| | | | | | - Francisco Javier Briceño Delgado
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GC18 Translational Research in Surgery of Solid Organ Transplantation - Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
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Messner F, Etra JW, Haugen CE, Bösmüller C, Maglione M, Hackl H, Riedmann M, Oberhuber R, Cardini B, Resch T, Scheidl S, Margreiter R, Öfner D, Schneeberger S, Margreiter C. Sex matching does not impact the outcome after simultaneous pancreas-kidney transplantation. Clin Transplant 2019; 33:e13717. [PMID: 31545525 PMCID: PMC6899671 DOI: 10.1111/ctr.13717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/11/2019] [Accepted: 09/18/2019] [Indexed: 01/31/2023]
Abstract
Background Several studies in solid organ transplantation have shown a correlation between donor and recipient sex mismatch and risk of graft loss. In this study, we aimed to analyze the impact of donor and recipient sex matching on patient and pancreas graft survival in a large single‐center cohort. Methods We retrospectively analyzed all first simultaneous pancreas‐kidney transplants performed between 1979 and 2017 at the Medical University of Innsbruck. Results Of 452 patients, 54.6% (247) received a sex‐matched transplant. Patient survival (P = .86), death‐censored pancreas graft survival (dcPGS, P = .26), and death‐censored kidney graft survival (dcKGS, P = .24) were similar between the sex‐matched and sex‐mismatched groups. Patient survival and dcPGS at 1, 5, and 15 years were 95.9%, 90.0%, and 62.1% and 86.1%, 77.1%, and 56.7% in the sex‐matched group and 93.6%, 86.2%, and 62.4% and 83.1%, 73.3%, and 54.3% in the sex‐mismatched group. Sex matching led to a lower odds of severe postoperative complications (41.2% vs 49.0%; OR 0.57, 95%CI 0.33‐0.97; P = .038); however, no increased odds of other adverse postoperative outcomes was detected. Conclusion Our study demonstrates that sex matching reduced the odds of postoperative complications but did not impact other early and late outcome parameters in our cohort.
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Affiliation(s)
- Franka Messner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Joanna W Etra
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claudia Bösmüller
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Hubert Hackl
- Division of Bioinformatics, Medical University of Innsbruck, Biocenter, Innsbruck, Austria
| | - Marina Riedmann
- Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Rupert Oberhuber
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Benno Cardini
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Resch
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Scheidl
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Margreiter
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Margreiter
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Teegen EM, Krebs I, Langelotz C, Pratschke J, Rau B. Gender Mainstreaming and Transplant Surgery. Visc Med 2016; 32:286-289. [PMID: 27722166 DOI: 10.1159/000446357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Gender differences in medicine are gaining in importance. In transplant surgery, not only the patient's gender but also that of the donor play an important role in the outcome of transplantation due to sociocultural and genetic factors. METHODS This review article gives an overview of the latest investigations into gender-related influences in the field of visceral transplantation. For this purpose, a systematic review of the literature was performed. RESULTS In general, women are less often evaluated for and subjected to transplantation worldwide. Significantly poorer outcome can be observed in women with liver transplantation following hepatitis C cirrhosis. Furthermore, female renal grafts are less favorable in terms of outcome and survival. Gender disparities affect transplant medicine due to subtle gender-specific immunological factors. Sociocultural factors also lead to differences in the clinical treatment of men and women, which may influence overall survival. CONCLUSION For a better understanding of gender-specific differences in transplant medicine and a possible improvement in outcome, further research in this field is necessary.
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Affiliation(s)
- Eva Maria Teegen
- Department of General, Visceral and Transplant Surgery, Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Isabell Krebs
- Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Corinna Langelotz
- Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of General, Visceral and Transplant Surgery, Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Beate Rau
- Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Influence of donor-recipient sex mismatch on long-term survival of pancreatic grafts. Sci Rep 2016; 6:29298. [PMID: 27403718 PMCID: PMC4941418 DOI: 10.1038/srep29298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 06/17/2016] [Indexed: 12/11/2022] Open
Abstract
To assess the role of sex mismatch on graft survival after pancreas transplantation. We evaluated 24,195 pancreas-transplant recipients reported in the Scientific Registry of Transplant Recipients over a 25-year period. Pancreatic graft survival (PGS) was analyzed according to donor–recipient sex pairing using Kaplan–Meier estimations. Hazard ratios were estimated using Cox proportional hazard models. A total of 14,187 male and 10,008 female recipients were included in final analyses. Mean follow-up was 8.3 ± 5.7 years. In multivariate analyses, neither recipient sex nor donor sex was associated with pancreatic graft failure (PGF), but donor–recipient sex mismatch (regardless of recipient sex) was an independent predictor of PGS (HR, 1.09; 95% CI, 1.04–1.14; p < 0.001). Compared with M → M sex-matched recipients in univariate analyses, M → F and F → M sex mismatches were associated with an increased risk of PGF. Adjustment for significant recipient and donor factors eliminated the association between F → M sex mismatch and PGF (HR, 1.02; 95% CI, 0.93–1.10; p = 0.752), but not M → F (1.09; 1.02–1.17; 0.020). Stratified analyses suggested that the negative effect of donor–recipient sex mismatch could be neutralized in older patients. These findings suggest that donor–recipient sex pairing should be taken into consideration in organ-allocation strategies.
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Fellmer PT, Pascher A, Kahl A, Ulrich F, Lanzenberger K, Schnell K, Jonas S, Tullius SG, Neuhaus P, Pratschke J. Influence of donor- and recipient-specific factors on the postoperative course after combined pancreas-kidney transplantation. Langenbecks Arch Surg 2010; 395:19-25. [PMID: 19730880 DOI: 10.1007/s00423-009-0552-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 08/20/2009] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Simultaneous pancreas-kidney (SPK) transplantation is state-of-the-art therapy for patients with type-1 diabetes mellitus and end-stage renal failure. Improvement of long-term organ function and long-term survival after transplantation is the main focus of current research, but improvement of the early postoperative course is very important for the patient. Pancreas transplantation is associated with postoperative complications. We defined and identified donor- and recipient-specific factors related to postoperative complications. PATIENTS AND METHODS We carried out 210 SPKs from April 1995 to December 2007. The early postoperative course until first discharge from hospital was analyzed. Complications (pancreas-specific and surgical) were revisited. Donor-specific factors such as sex, age, body mass index (BMI), laboratory values, catecholamine administration, time in the intensive care unit, preprocurement blood substitution, and asystolic periods, as well as factors related to the organ donation procedure, were assessed. Recipient-specific factors such as age, sex, BMI, and blood group were correlated with the prevalence of complications and postoperative outcome. Donor-specific risk factors correlating with postoperative complications included donor age, BMI, and blood transfusion in the donor before organ donation. RESULTS Graft preservation with histidine-tryptophan-ketoglutarate perfusion solution was related to a significantly higher number of surgical complications.When analyzing recipient-specific factors, pre-existing cardiac diseases influenced the prevalence of postoperative complications. The duration of the transplantation procedure was associated with significantly more complications. The anastomosis time was not significantly related to an increased prevalence of complications. The choice of immunosuppression had a significant effect on pancreas-specific complications, demonstrating that antithymocyte globulin instead of daclizumab had a negative effect. Initial immunosuppression with tacrolimus combined with mycophenolate mofetil (MMF) caused significantly fewer pancreas-related complications in comparison with tacrolimus combined with rapamycin as well as compared with cyclosporine combined with MMF. A high level of C-reactive protein within the first 7 days after transplantation was significantly related to an increased prevalence of complications. CONCLUSIONS Early postoperative complications after combined pancreas-kidney transplantation have a considerable effect on short- and long-term outcomes. Several statistically relevant factors related to pancreas- or surgery-associated complications could be identified. These data may help to improve early outcome after SPK by consideration of relevant risk factors when choosing an organ and a recipient for transplantation.
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Affiliation(s)
- Peter Thomas Fellmer
- Department of General, Visceral- and Transplant Surgery, Charité Campus Virchow, Berlin, Germany
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