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Abstract:
1. In 9 yearly cohorts from 1978 to 1986, male and female recipients had the same one-year graft survival rates for first cadaver donor grafts. For regrafts, female recipients had superior survival in 2 out of the 9 years. 2. In contrast, in the same 9 yearly cohorts, female donor first cadaver grafts had a lower survival than male donors in 8 out of the 9 comparisons, although the difference was not statistically significant. For regrafts for the last 5 years, in 4 different years females had a statistically significant lower graft survival rate compared to males. 3. The lower survival rate of female donor kidneys was especially evident in the CsA-treated regrafted patients, although a similar tendency was noted also in non-CsA-treated regraft patients. 4. Grafts from females older than 30 years had the lower survival rate in the regrafted patients. 5. The depressed survival effect of female donor kidneys was not affected by the recipient's sex or original disease. 6. Female donors kidneys from either trauma or nontrauma donors yielded lower survival rates. Thus, the cause of death in the donor is probably not the principal explanation for the donor sex effect. Since males more often die from trauma, it was initially thought that the sex effect could be attributed to the difference in mode of death of the donor. 7. Regrafts from living-related female donors who differ by one HLA haplotype had a lower regraft survival rate than grafts from male donors. 8. It is unlikely that a sex-associated histocompatibility antigen exists in the clinical kidney transplant situation since females who received 2 grafts from male donors had a statistically significant superior survival to females who received 2 successive grafts from female donors. Thus, rejection of a male graft by a female does not sensitize the recipient to a second male graft, and second female grafts when the first was a female result in a lower graft survival. 9. Poor mismatches for HLA-A, B, or DR antigens were more deleterious with female donors than male donors. With CsA, the lower regraft survival with female donors was statistically significant in all categories of DR mismatches. 10. Transfusions did not influence the donor sex effect. The level of panel reactive antibody also did not affect the lower survival of female donor kidneys. 11. The donor sex effect was apparent in first grafts and regrafts even one month after transplantation.