Previous data have suggested an increased risk of graft failure in male recipients of female livers, and in nonwhite recipients of orthotopic liver transplantation. United Network for Organ Sharing records of liver transplantations from 1992 through 2000 with at least one follow-up visit were reviewed. Analysis of these data was performed with proportional hazards regression, controlling for follow-up time, age, gender, ethnicity, number of comorbidities, functional status at time of transplant, and status 1 designation. Separate analyses comparing transplants among whites and blacks only and matched versus mismatched transplants for male and female recipients were performed. The results revealed that gender-mismatched patients (n = 13, 992) had a higher likelihood of graft failure when compared with gender matched transplants (n = 18, 522) (12.2% versus 11.3% respectively, P =.013). After controlling for the above potential confounders, gender-mismatched patients were found to have a 6.9% increase in likelihood of graft failure, (P =.042). Female recipients receiving male organs had no significant change in the risk of graft failure (11.5%; P =.368). A worse outcome was found in male recipients receiving female organs (12.9%; P =.0003). Graft failure rate among patients with donors matched by race (white to white or nonwhite to nonwhite; n = 21, 818) was 11.6% versus 11.9%, and among unmatched patients (n = 10, 697), the difference was not significant (P =.33). Multivariate regression analysis controlling for potential confounders confirmed that this difference was not significant (P =.21). Mismatch between black donors and white recipients was found to increase the risk of liver graft failure (27.4%, P = <.0001), independently of gender, number of comorbidities, and functional status at time of transplant.
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