Sex-Based Differences in Rejection Among Pediatric Solid Organ 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.