Outcomes of Donor-Recipient Gender Mismatched Lung Transplantation in the Eurotransplant Area

Purpose An effect of donor-recipient gender mismatching on long-term survival outcomes following organ transplantation has been postulated but remains controversial. We aimed to investigate the influence of gender mismatches on long-term survival after lung transplantation in the Eurotransplant area. Methods In this retrospective, multicentre study in the Eurotransplant area, all lung transplants performed from DBD lungs in the period from 01.01.2000 until 31.12.2015 were included. A total of 7688 lung transplant recipients (≥ 14 years old) for long-term survival and the effect of gender mismatches (Kaplan-Meier, multivariate regression). Results More men (4079; 52 %) were transplanted compared to women (3609; 48%). Women had better survival outcomes compared to men with a median survival of 3159 days for women compared to 2396 days for men (p<0.0001). Mean age was 50 years for women (range 14-69 years) respectively 53 years (range 14-72 years) for men (p<0.0001). Lungs were mostly donated by men (52.8%). Gender of the donor alone did not influence survival. A combination of a female donor transplanted into a male (FM; n= 964) showed a median survival of 1681 days, whereas a gender matched transplant showed a median survival of 3207 (female-female (FF); n= 2910) respectively 2594 days (male-male (MM) n=3116) (p<0.0001). A male donor transplanted into a female showed a median survival of 2754 days (n= 698). Although donor age (HR 1.00-1.005) and recipient age (HR 1.01 -1.015) influenced survival, multivariate analysis showed that especially the female donor lung transplanted into a male recipient was of influence (FM vs. FF, HR 1.303-1.581; FM vs. MM, HR 1.173-1.412; FM vs MF, HR 1.109-1.44) Conclusion Women had better survival outcomes than men but women were significantly younger when transplanted. A female donor transplanted into male had a significant worse survival and needs further elucidation. An effect of donor-recipient gender mismatching on long-term survival outcomes following organ transplantation has been postulated but remains controversial. We aimed to investigate the influence of gender mismatches on long-term survival after lung transplantation in the Eurotransplant area. In this retrospective, multicentre study in the Eurotransplant area, all lung transplants performed from DBD lungs in the period from 01.01.2000 until 31.12.2015 were included. A total of 7688 lung transplant recipients (≥ 14 years old) for long-term survival and the effect of gender mismatches (Kaplan-Meier, multivariate regression). More men (4079; 52 %) were transplanted compared to women (3609; 48%). Women had better survival outcomes compared to men with a median survival of 3159 days for women compared to 2396 days for men (p<0.0001). Mean age was 50 years for women (range 14-69 years) respectively 53 years (range 14-72 years) for men (p<0.0001). Lungs were mostly donated by men (52.8%). Gender of the donor alone did not influence survival. A combination of a female donor transplanted into a male (FM; n= 964) showed a median survival of 1681 days, whereas a gender matched transplant showed a median survival of 3207 (female-female (FF); n= 2910) respectively 2594 days (male-male (MM) n=3116) (p<0.0001). A male donor transplanted into a female showed a median survival of 2754 days (n= 698). Although donor age (HR 1.00-1.005) and recipient age (HR 1.01 -1.015) influenced survival, multivariate analysis showed that especially the female donor lung transplanted into a male recipient was of influence (FM vs. FF, HR 1.303-1.581; FM vs. MM, HR 1.173-1.412; FM vs MF, HR 1.109-1.44) Women had better survival outcomes than men but women were significantly younger when transplanted. A female donor transplanted into male had a significant worse survival and needs further elucidation.