The impact of sex and age matching for long-term graft survival in living donor renal transplantation

Background. Deficient functional renal mass leads to progressive renal injury owing to the detrimental effects of glomerular hyperfiltration. Therefore, renal transplant mass is an important determinant of outcome. Materials and Methods. We retrospectively analyzed 614 living donor renal transplantations performed from 1979 to 2002. Patients were divided into 4 groups according to donor-recipient gender differences: group 1 (male to male), group 2 (male to female), group 3 (female to male), and group 4 (female to female). We analyzed the clinical and immunological data to compare the 4 groups with respect to long-term graft survival, age gender, acute rejection episodes an HLA matching. We used the Kaplan-Meier method with the log-rank test to assess graft survival. Results. The actuarial graft survival rate was 86.24% at 5 years for donors younger than 50 years of age compared with 73.15% for those older than 50 years (P = .0000). The graft survival from younger donors than recipients was 85.23% at 5 years compared with 80.35% for older donors (P = .0213). The graft survival of group 3 (female donor to male recipient) was 75.12% at 5 years compared with 85.72%, 85.33%, and 83.16% for groups 1, 2, and 4, respectively (P = .0165). The main parameters significantly associated with graft survival were donor age (P = .0000), acute rejection episode (P = .0000), donor gender (P = .0215). HLA-DR matching (P = .0516), and donor and recipient age matching (P = .0213). Conclusions. The results suggest that the sex and age matching between donors and recipients should be considered as a criterion in the choice of donor and recipient pairs for living donor renal transplantation.