Effect of donor and recipient gender on the recovery of renal function after donation after cardiac death renal transplantation

doi:10.3969/j.issn.2095-4344.2017.16.023

Abstract

Abstract:

BACKGROUND: Donation after cardiac death (DCD) is becoming the main source of organs for transplantation. Donor and recipient gender may play an important role in preoperative evaluation and recipient selection of transplantation.

OBJECTIVE: To analyze the effect of donor and recipient gender on the recovery of renal function after DCD renal transplantation, and to further guide the selection of recipients.

METHODS: The clinical data of recipients and donors of DCD kidney transplantation performed at the First Affiliated Hospital of Zhengzhou University from July 2012 to March 2015 were analyzed retrospectively. According to donor and recipient gender, the donors and recipients were divided into four groups: group A (male donor, male recipient), group B (male donor, female recipient), group C (female donor, male recipient), group D (female donor, female recipient). The renal function of the recipients was recorded at 1 and 2 weeks, 1, 3, 6, and 12 months postoperatively to compare the effect of donor and recipient gender on the recovery of renal function.

RESULTS AND CONCLUSION: The serum creatinine level in the groups A and B was lower than that in the groups C and D at postoperative different time points, and there was a significant difference at 3, 6 and 12 months postoperatively (P < 0.05). The estimated glomerular filtration rate in the groups A and B was significantly higher than that in the groups C and D at postoperative different time points (P < 0.05). The serum creatinine level in the group C was significantly higher than that in the other three groups at postoperative different time points (P < 0.05). The serum creatinine level in the group A was significantly higher than that in the group B at 3, 6 and 12 months postoperatively (P < 0.05). The glomerular filtration rate in the group A was significantly higher than that in the group C at postoperative different time points (P < 0.05). The glomerular filtration rate in the group B was significantly higher than that in the group D at 12 months postoperatively (P < 0.05). These results suggest that the male donors show superior renal function to the female donors. The postoperative recovery of renal function is relatively slow when the male recipients receive a kidney of female donors. The female recipients with lower body surface area who receive the kidney of elderly male donors with poor renal function can achieve favorable clinical effects. Therefore, the gender should be used as a reference index for selecting potential recipients.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Kidney Transplantation, Sex Factors, Tissue Donors, Tissue Engineering

CLC Number:

R318

Li Jin-feng, Sun Jia-jia, Feng Gui-wen, Shang Wen-jun, Pang Xin-lu, Liu Lei, Xie Hong-chang, Feng Yong-hua, Wang Zhi-gang. Effect of donor and recipient gender on the recovery of renal function after donation after cardiac death renal transplantation[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(16): 2593-2599.

Figures/Tables 3

2.1 受试者数量分析研究最终纳入69例供者和127例受者，男性供者58例，女性供者11例；男性受者100例，女性受者27例。男性受者接受男性供肾87例，女性受者接受男性供肾21例，男性受者接受女性供肾13例，女性受者接受女性供肾6例；所有受者均接受半年以上规律随访，其中随访1年以上的受者为89例。分组流程图见图1。 2.2 不同性别供/受者体表面积比值的比较 127例受者中，男性供者供肾移植108例，女性供者供肾移植19例。108例男性受者体表面积为1.34-2.21 m2，平均为(1.74±0.14) m2，19例女性受者体表面积为1.37-1.79 m2，平均为(1.54±0.11) m2，男性受者体表面积明显高于女性受者，差异有显著性意义(P < 0.05)。依据供、受者性别将受者分为4组：A组(男性供者，男性受者)，B组(男性供者，女性受者)，C组(女性供者，男性受者)，D组(女性供者，女性受者)；A组供/受者体表面积比为0.79-1.25 m2，平均为(1.04±0.09) m2，B组为0.98-1.27 m2，平均为(1.17±0.08) m2，C组为0.81-1.13m2，平均为(0.95±0.11) m2，D组为0.99-1.28 m2，平均为(1.09±0.11) m2。B组的供/受者体表面积比高于A、D组，C组的供/受者体表面积比低于A、D组，差异均有显著性意义(P < 0.05)。 2.3 供者性别对受者移植肾功能恢复的影响接受6个月规律随访的受者共127例，其中男性供者组108例，女性供者组19例；接受12个月规律随访的受者共89例，其中男性供者组80例，女性供者组9例。比较男性、女性供者组相应受者移植后1年内的肾功能变化情况：男性供者相应受者移植后各时间点肌酐值均低于女性供者，移植后2周、1个月两组间差异无显著性意义(P≥0.05)，移植后1周、3个月、6个月、12个月差异有显著性意义(P < 0.05)，见表1、图2。男性供者相应受者移植后各时间点肾小球滤过率均高于女性供者，且移植后1周、2周、1个月、3个月、6个月及12个月两组间差异均有显著性意义(P < 0.05)，见表2、图3。 2.4 受者性别对受者移植肾功能恢复的影响将接受同一供者供肾而性别不同的2名受者进行配对分析，共纳入10对(20例)受者，均接受12个月以上的规律随访。比较男性受者组与女性受者组肾功能恢复情况：男性受者组移植后各时间点血肌酐值均高于女性受者组，其中1，3，6，12个月差异有显著性意义，见表3；男性受者组移植后各时间点肾小球滤过率均低于女性受者组，但差异无显著性意义(P ≥ 0.05)，见表4。 2.5 综合考虑供、受者性别对受者移植肾功能恢复的影响接受1周、2周、1个月、3个月、6个月规律随访的受者共127例，A组(男性供者，男性受者)87例，B组(男性供者，女性受者)21例，C组(女性供者，男性受者)13例，D组(女性供者，女性受者)6例；接受12个月以上规律随访的受者89例，A组63例，B组17例，C组5例，D组4例。分别比较4组间的供、受者移植前评估资料示：4组的供者年龄、受者手术年龄、HLA抗原错配数、冷、热缺血时间以及术后免疫抑制剂选择之间差异无显著性意义(P≥0.05)；男性供、受者体质量与体表面积大于女性供、受者，差异有显著性意义(P < 0.05)；B组供者末次血肌酐值均大于其他3组，差异有显著性意义(P < 0.05)；B组的供/受者体表面积比高于A、D组，C组的供/受者体表面积比低于A、D组，差异有显著性意义(P < 0.05)，见表5。 4组受者肾功能均在移植后第1周内迅速改善，1周后肾功能缓慢恢复到正常水平并逐渐稳定。C组(女性供者，男性受者)移植后1周、2周、1个月、3个月、6个月及12个月受者血肌酐值均高于其他3组，且各时间点差异有显著性意义(P < 0.05)；A、B、D 3组间受者血肌酐值于移植后1周、2周、1个月差异无显著性意义(P≥0.05)，3，6，12个月A组(男性供者，男性受者)受者的血肌酐值高于B组(男性供者，女性受者)，差异有显著性意义(P < 0.05)，见表6、图4。A组(男性供者，男性受者)受者移植后各时间点肾小球滤过率值始终高于C组(女性供者，男性受者)，且差异有显著性意义(P < 0.05)，B组(男性供者，女性受者)受者移植后3，6，12个月肾小球滤过率值高于D组(女性供者，女性受者)，随访6个月内差异无显著性意义(P ≥0.05)，随访12个月两者差异有显著性意义(P < 0.05)，见表7、图5。"

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