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.