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Updated: May 16, 2025
Investigating the Immunological Mechanisms Underlying Organ Transplant Rejection
Published on: August 20, 2007
Sex-Based Differences in Rejection Among Pediatric Solid Organ Transplant Recipients
Luke J Dotson1, Ashley Montgomery1, Josephine Schmidt1
1School of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Insights
Pediatric males show a reduced risk of acute rejection in liver, lung, and kidney transplants. This finding may help tailor immunosuppression strategies for young transplant recipients.
Area of Science:
- Transplantation immunology
- Pediatric medicine
- Organ transplantation outcomes
Background:
- Immunosuppression is crucial for preventing solid organ transplant rejection but increases infection and malignancy risks.
- Personalizing immunosuppression in pediatric patients is vital to mitigate these risks.
- Identifying factors influencing rejection can optimize treatment for vulnerable children.
Purpose of the Study:
- To identify independent risk factors for treated acute rejection in pediatric solid organ transplant recipients.
- To analyze differences in rejection rates based on recipient sex across various organ transplants.
- To inform potential adjustments in immunosuppression strategies for pediatric transplant patients.
Main Methods:
- Retrospective review of public data from the Organ Procurement and Transplantation Network (1998-2022).
- Analysis included pediatric patients undergoing kidney, liver, lung, and heart transplantation.
- Univariate and multivariate logistic regression models were used to assess risk factors for acute rejection at 6 months and 1 year post-transplant.
Main Results:
- Male recipients demonstrated a statistically significant lower risk of acute rejection in liver (OR=0.85), lung (OR=0.61), and kidney (OR=0.91) transplants.
- This protective effect of male sex was not observed in heart transplant recipients (OR=0.96).
- Rejection rates at 1 year varied by organ, with females generally showing higher rates in liver and lung transplants.
Conclusions:
- Pediatric males may experience a lower risk of acute rejection in liver, lung, and kidney transplants compared to females.
- The findings suggest potential sex-based differences in the immune response to transplanted organs.
- These results could guide personalized immunosuppression protocols for pediatric transplant recipients, particularly males.
Background:
Immunosuppression is paramount to prevent acute rejection in solid organ transplant but also poses a risk for infection and malignancy. Identifying factors that influence rejection may allow for personalization of treatment and avoidance of an unnecessary degree of immunosuppression for the vulnerable pediatric population.
Methods:
We conducted a retrospective review analyzing public data provided by the Organ Procurement and Transplantation Network for pediatric patients listed for solid organ transplantation (kidney, liver, lung, and heart) from March 1998 to December 2022. Univariate and multivariate logistic regression was used to identify independent risk factors for treated acute rejection at 6 months and/or 1 year for liver, lung, kidney, and heart transplants.
Results:
The study population consisted of the following pediatric patients for each organ studied: liver (n = 8993), lung (n = 846), heart (n = 7118), and kidney (n = 14 600). At 1 year, 28.4% and 31.7% of males and females, respectively, were treated for rejection in liver transplant, 24.1% and 34.5%, respectively, for lung, 14.8% and 16.2%, respectively, for kidney, and 25.2% for both in heart transplant. In multivariate analysis, male recipient status was a statistically significant protective factor against rejection in liver transplant, OR = 0.85 (p < 0.001), lung transplant, OR = 0.61 (p = 0.004), and kidney transplant, OR = 0.91 (p = 0.040), but not heart transplant, OR = 0.96 (p = 0.460).
Conclusions:
Our study demonstrates that pediatric males may have a lower risk of acute rejection in liver, lung, and kidney transplant yet not in heart transplant. These findings may have implications for the level of maintenance immunosuppression for pediatric male transplant recipients.
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