# Female donor gender is associated with a decrease in liver transplant survival of male recipients independent of donor and recipient anthropometrics

## TL;DR

Male liver transplant recipients who receive livers from female donors have worse survival rates, even when body size differences are not a factor.

## Contribution

This study identifies female donor gender as a novel independent predictor of increased mortality in liver transplant recipients, particularly in males.

## Key findings

- Female donor gender was the only significant predictor of increased mortality after liver transplant [HR 1.918, 95%CI 1.150–3.201, p=0.013].
- Male recipients of livers from female donors had higher mortality rates, with infection being the most common cause in the first year.
- Anthropometric differences between donor and recipient were not related to mortality outcomes.

## Abstract

Data on the influence of donor gender on post-liver transplant outcomes is scarce and is lacking.

The aim of this study was to evaluate the prognostic factors of mortality in patients undergoing liver transplantation (LT) with a thorough evaluation of the influence of the donor variables.

All patients undergoing LT at a single center from December 2011 to December 2018 were included. The main outcome measure of the study was overall patient survival. The mortality predictors were evaluated using Cox regression.

The study analyzed 202 patients, 118 (58.1%) being males, and the average age was 54.19±11.66 years. Post-LT survival for the entire cohort of 202 patients as assessed by the KaplanMeier method at 1, 3, 5, and 7 years was 81.6, 73.1, 67.6, and 63%, respectively. The only predictor of increased overall mortality was female donor gender [HR 1.918, 95%CI 1.150–3.201, p=0.013]. Weight and height differences between donor and recipient were not related to mortality (p=0.545 for weight and p=0.964 height).

Female donor gender was associated with an increase in overall post-LT mortality, especially for male recipients, regardless of anthropometric parameters. For male patients receiving livers from female donors, infection was the most common cause of mortality, occurring in the first year following LT.

Post-liver transplant survival has achieved little improvement over the last decade.

Data on the influence of donor gender on post-liver transplant outcomes is scarce.

Analyzing a cohort of 202 consecutive patients receiving a liver transplant, female donor gender was the only predictor of increased overall mortality [HR 1.918, 95%CI 1.150–3.201, p=0.013].

The reason for those inferior outcomes related to LT employing livers from female donors was not related to anthropometric differences.

Post-liver transplant survival has achieved little improvement over the last decade. Several prognostic factors of mortality after liver transplant have been identified, including donor age, long cold ischemia time, long warm ischemia time, moderate hepatic steatosis in the donor, and others. However, data on the influence of donor gender on post-liver transplant outcomes is scarce.

The female donor gender was associated with an increase in overall post-liver transplant mortality, especially for male recipients. The reason for those inferior outcomes of males receiving livers from female donors was not related to anthropometric differences. For male patients receiving livers from female donors, infection was the most common cause of mortality occurring in the first year following LT. Future studies are needed to elucidate whether immune discrepancies would be accountable for increased mortality of males receiving livers from female donors.