Donor gender effect on graft function in adult Egyptian patients undergoing living donor liver transplantation: A single centre study

Figures & data

Figure 1. Flow chart of the included subjects.

Table 1. Baseline demographic characteristics of the recipients and donors

				Matched group N = 214 (62.6%)	Mismatched group N = 128 (37.4%)	Total N = 342	P value
Recipients	Gender	Female	N	17	34	51	<0.001*
			%	7.9%	26.6%	14.9%
		Male	N	197	94	291
			%	92.1%	73.4%	85.1%
	Age (Years)	Mean ± SD		50.0 ± 8.5	49.0 ± 9.5	49.7 ± 8.9	0.317
	BMI (kg/m^2)	Mean ± SD		28.5 ± 4.7	28.0 ± 4.1	28.3 ± 4.5	0.355
Donors	Gender	Female	N	16	94	110	<0.001*
			%	7.5%	73.4%	32.2%
		Male	N	198	34	232
			%	92.5%	26.6%	67.8%
	Age (Years)	Mean ± SD		29.9 ± 6.3	29.8 ± 6.6	29.8 ± 6.4	0.866
	BMI (kg/m^2)	Mean ± SD		23.55 ± 2.51	23.91 ± 2.72	23.69 ± 2.60	0.207

BMI: body mass index; N: number; SD: standard deviation; *Significant at p < 0.05.

Table 2. Clinical and operative characteristics of the gender matched and mismatched groups

		Matched group N = 214 (62.6%)		Mismatched group N = 128 (37.4%)		P value
Medical history	Irrelevant	142	66.4%	83	64.8%	0.858
	Diabetes Mellitus	45	21.0%	27	21.1%
	Diabetes Mellitus/ Hypertension/ Chronic heart disease	11	5.1%	11	8.6%
	Hypertension	5	2.3%	3	2.3%
	Ischemic heart disease	2	0.9%	0	0.0%
	Chronic kidney disease	1	0.5%	0	0.0%
	Others	8	3.7%	4	3.1%
Hepatitis C virus	No	59	27.6%	25	19.5%	0.095
	Yes	155	72.4%	103	80.5%
Hepatitis B virus	No	206	96.3%	124	96.9%	>0.999
	Yes	8	3.7%	4	3.1%
Hepatocellular carcinoma	No	121	56.5%	88	68.8%	0.025*
	Yes	93	43.5%	40	31.3%
Cryptogenic	No	183	85.5%	122	95.3%	0.005*
	Yes	31	14.5%	6	4.7%
Portal vein thrombosis	No	192	89.7%	108	84.4%	0.145
	Yes	22	10.3%	20	15.6%
Encephalopathy	No	145	67.8%	86	67.2%	0.913
	Yes	69	32.2%	42	32.8%
MELD score	Median (IQR)	15.0 (13.0–18.0)		16.0 (12.5–18.0)		0.793
Intraoperative packed RBCs	No	76	35.5%	44	34.4%	0.831
	Yes	138	64.5%	84	65.6%
Packed RBCs (Units)	Median (IQR)	4.0 (2.0–7.0)		4.0 (2.0–7.0)		0.649
Cold ischemia time (Min)	Median (IQR)	45.0 (30.0–60.0)		45.0 (34.0–60.0)		0.930
Warm ischemia time (Min)	Median (IQR)	45.0 (40.0–60.0)		45.0 (30.0–60.0)		0.616
Graft-weight ratio (%)	Median (IQR)	1.10 (0.90–1.20)		1.08 (0.90–1.20)		0.666

N: number; RBCs: Red blood cells; IQR: inter quartile ratio; *Significant at p < 0.05.

Table 3. Outcomes of the gender matched and mismatched groups

		Matched group N = 214 (62.6%)		Mismatched group N = 128 (37.4%)		P value
Medical graft failure	No	197	92.1%	108	84.4%	0.027*
	Yes	17	7.9%	20	15.6%
Surgical graft failure	No	167	78.0%	114	89.1%	0.010*
	Yes	47	22.0%	14	10.9%
Causes of surgical/vascular failure	Bleeding	1	0.5%	0	0.0%	0.457
	Hepatic artery stenosis	5	2.3%	1	0.8%
	Hepatic artery thrombosis	25	11.7%	7	5.5%
	Hepatic artery aneurysm bleeding	1	0.5%	0	0.0%
	Hepatic vein stenosis	2	0.9%	2	1.6%
	Hepatic vein thrombosis	1	0.5%	0	0.0%
	Intraoperative bleeding	1	0.5%	1	0.8%
	Portal vein stenosis	3	1.4%	1	0.8%
	Portal vein thrombosis	7	3.3%	2	1.6%
	Sub-diaphragmatic hematoma	1	0.5%	0	0.0%
	No	167	78.0%	114	89.1%
Mortality	No	136	63.6%	75	58.6%	0.361
	Yes	78	36.4%	53	41.4%
Length of ICU stay (Days)	Median (IQR)	5.0 (3.0–5.0)		5.0 (4.0–5.0)		0.845
Length of hospital stay (Days)	Median (IQR)	21.0 (16.0–25.0)		21.0 (14.0–25.0)		0.874
Duration of follow up (Months)	Median (IQR)	31.0 (5.0–80.0)		27.5 (3.5–61.5)		0.382

IQR: inter quartile ratio; N: number; *Significant at p < 0.05.

Figure 2. Kaplan-Meier survival analysis curves for graft rejection according to the recipient-donor gender matching.

Figure 3. Kaplan-Meier survival analysis curves for surgical graft failure according to the recipient-donor gender matching.

Table 4. Medical and surgical graft survival analysis according to the recipient-donor gender matching

	Groups		Log-rank test
	Matched group N = 214 (62.6%)	Mismatched group N = 128 (37.4%)	X2	P value
Mean graft survival time in months (95% CI)	119.21 (112.08–126.34)	105. 40 (94.84–115.95)	4.911	0.026*
Survival probability ± SE at 2y (%)	95.7 ± 0.017	89.1 ± 0.034
Hazard ratio of medical graft rejection (95% CI)	0.467(0.238–0.915)	2.14(1.09–4.18)
Mean graft survival time in months (95% CI)	101.39 (92.94–109.85)	115.60 (106.72–124.48)	5.128	0.023*
Survival probability ± SE at 2y (%)	– –	– –
Hazard ratio of surgical graft rejection (95% CI)	1.82(1.08–3.07)	0.547(0.324–0.922)

*Significant at p < 0.05; SE: standard error; CI: confidence interval.

Figure 4. Kaplan-Meier survival analysis curves for medical graft failure according to the four recipient-donor gender matches.

Figure 5. Kaplan-Meier survival analysis curves for surgical graft failure according to the four recipient-donor gender matches.

Table 5. Medical and surgical graft survival analysis according to the four subgroups of recipient-donor gender matches

	Subgroups				Log-rank test
	F-M N = 94 (27.5%)	F-F N = 16(4.7%)	M-F N = 35(10.2%)	M-M N = 197 (57.6%)	X2	P value
Medical graft survival
Mean graft survival time in months (95% CI)	111.60 (101.0–122.21)	91.86 (64.96–118.77)	62.95 (44.91–80.99)	89.65 (86.47–92.83)	20.97	<0.001*
Survival probability ±SE at 2y (%)	87.30 ± 4.20	81.70 ± 12.30	61.30 ± 12.80	94.80 ± 2.08
Hazard ratio of rejection (95% CI) To F-M To F-F To M-F To M-M	-0.41 (0.06–2.89) 0.30 (0.07–1.40) 1.78 (0.88–3.61)	2.47 (0.35–17.56)- 0.74 (0.07–7.83) 4.39 (0.64–29.99)	3.33 (0.72–15.47) 1.35 (0.13–14.22)- 5.91 (1.34–26.11)	0.56 (0.28–1.14) 0.23 (0.03–1.56) 0.17 (0.04–0.75)-
Surgical graft survival
Mean graft survival time in months (95% CI)	115.73 (105.88–125.598)	73.49 (45.76–101.23)	86.33 (75.78–96.87)	76.09 (70.72–81.45)	5.740	0.125
Survival probability ±SE at 2y (%)	89.30 ± 3.62	59.30 ± 16.80	89.30 ± 6.01	79.30 ± 3.17
Hazard ratio of rejection (95% CI) To F-M To F-F To M-F To M-M	-0.37 (0.10–1.42) 0.96 (0.35–2.65) 0.51 (0.29–0.90)	2.68 (0.70–10.22)- 2.58 (0.55–12.10) 1.37 (0.38–5.03)	1.04 (0.38–2.87) 0.39 (0.08–1.83)- 0.53 (0.20–1.39)	1.95 (1.11–3.44) 0.73 (0.20–2.67) 1.88 (0.72–4.91)-

*Significant at p < 0.05; N: number; CI: confidence interval; F: female; M: Male.

Figure 6. Kaplan-Meier survival analysis for overall patients’ survival according to the recipient-donor gender matching.

Figure 7. Kaplan-Meier survival analysis for overall patients’ survival according to the four recipient-donor gender matches.

Table 6. Kaplan-Meier recipient survival analysis according to the recipient-donor gender matching

	Groups		Log-rank test
	Matched N = 214 (62.6%)	Mismatched N = 128 (37.4%)	X2	P value
Mean recipient survival time in months (95% CI)	87.07 (78.45–95.69)	78.48 (67.29–89.66)	0.789	0.374
Survival probability ±SE at 2y (%)	66.8 ± 0.032	63.8 ± 0.043
Hazard ratio (95% CI)	0.850(0.594–1.21)	1.17(0.822–1.68)

SE: standard error; CI: confidence interval.

Table 7. Kaplan-Meierrecipient survival analysis according to the four subgroups of recipient-donor gender matches

	Subgroups				Log-rank test
	F-M sub-group N = 94(27.5%)	F-F sub-group N = 16(4.7%)	M-F sub-group (10.2%)	M-M sub-group N = 197 (57.6%)	X2	P value
Mean patient survival time in months (95% CI)	84.20 (71.59–96.80)	68.31 (42.63–93.99)	49.74 (34.52–64.95)	62.54 (56.47–68.60)	3.032	0.387
Survival probability ±SE at 2y (%)	65.40 ± 5.10	61.10 ± 12.60	51.30 ± 9.00	65.20 ± 3.46
Hazard ratio (95% CI) To F-M To F-F To M-F To M-M	-0.94 (0.39–2.25) 0.66 (0.34–1.28) 1.037 (0.70–1.54)	1.07 (0.45–2.57)- 0.70 (0.26–1.91) 1.11 (0.48–2.58)	1.52 (0.78–2.94) 1.42 (0.52–3.86)- 1.58 (0.85–2.93)	0.96 (0.65–1.43) 0.90 (0.39–2.10) 0.63 (0.34–1.18)-

*Significant at p < 0.05; SE: standard error; CI: confidence interval.