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Abstract: TH-PO900

Graft Outcomes in Spousal Donor Kidney Transplantation: Impact of Donor-Recipient Sex Mismatch

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Ryou, Seyoung, Seoul Saint Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)
  • Choi, Seunghyeok, Seoul Saint Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)
  • Lee, Hanbi, Seoul Saint Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)
  • Yang, Chul Woo, Seoul Saint Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)
  • Chung, Byung ha, Seoul Saint Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)

Despite increasing demand for kidney transplantation (KT) due to the rising prevalence of end-stage kidney disease (ESKD), the shortage of kidney donors remains critical. Spousal donors have emerged as an essential source for living donor kidney transplantation (LDKT) in modern nuclear families. Given that patients' sex is a biological characteristic, the mismatch between the donor and recipient's sex can potentially affect the survival and function of the transplanted kidney. Moreover, female recipients are exposed to donor HLA antigens during pregnancy, increasing the immunological risk. We aim to investigate the impact of donor-recipient sex mismatch on the outcomes of spousal donor kidney transplantation.


We analyzed 456 spousal donor kidney transplantation (SDKT) recipients at Seoul St. Mary's Hospital from 1986 to 2022. Recipients were categorized based on immunological risk determined by Panel Reactive Antibody. Among the 367 standard-risk SDKT recipients, 75 were husband-to-wife (H2W) and 292 were wife-to-husband (W2H). In the high-risk group of 89 SDKT recipients, 55 were H2W and 34 were W2H. We assessed graft survival and allograft rejection based on donor-recipient sex mismatch.


Long-term graft survival and the incidence of biopsy-proven acute rejection (BPAR) with 1 year after KT were comparable between H2W and W2H recipients in standard-risk group (10-year survival rate: 90.7% vs. 87.6%, p value = 0.428; incidence of BPAR: 3% vs. 7%, p value = 0.178). In the high-risk group, long-term graft survival was similar between H2W and W2H recipients (83.6% vs. 91.2%, p-value=0.593), while H2W recipients showed a higher incidence of BPAR within 1 year after KT compared to W2H recipients (3% vs. 17% p value = 0.044), mainly due to acute antibody-mediated rejection (AAMR).


Our findings indicate that donor-recipient sex mismatch does not have a significant impact on graft survival. However, among high-risk SDKT recipients, H2W SDKT recipients exhibited a higher risk of AAMR compared to W2H SDKT recipients, who face similar immunological risks. H2W SDKT recipients with a high immunological risk should receive careful management through personalized desensitization protocols and tailored immunosuppressant strategies to reduce the incidence of AAMR following KT.