瑞士学者的一项研究表明，如果肾移植供者与受者的性别相匹配，将导致更好的临床转归。研究者发现，当女性接受男性的供肾，其移植失败的发生率高于其他几种性别组合。这提示，以后进行器官移植时，应考虑供者和受者的性别。该文发表在爱思唯尔期刊《柳叶刀》（Lancet）上。
这并非是首次在供者——受者关系中提出性别问题。例如，在干细胞移植中，男性接受女性的移植物，更可能发生移植物抗宿主病；女性接受男性移植物，发生抗H-Y的排斥和免疫反应的危险增加。然而，H-Y抗原是否影响肾移植，还存在争议。
最近瑞士的一项回顾性队列研究，进一步分析了上述问题。该研究纳入195516例在1985年至2004年在欧洲400个医学中心接受肾移植者，研究者比较了1年和10年移植物的存活率。
结果显示，1年和10年后，与接受男性肾相比，接受女性肾者更可能发生移植肾丢失(P<0.001)。在1年末与10年末间，女性受者的移植肾失败率较低(P<0.001)。与所有其他性别组合相比，男性供肾女性受者移植后第1年和2~10年间的移植肾失败危险增加，分别增加8%和6%。
研究者说，多变量分析显示，男性供者给女性受者移植肾，引起移植肾失败的发生率增加，这提示H-Y抗原影响肾移植。
原始出处：
Lancet，372:49-53，Alois Gratwohl，Gerhard Opelz
a 
, b, a and b
In haematopoietic stem-cell transplantation, male recipients of female grafts have an increased risk of graft-versus-host disease and female recipients have both an increased risk of rejection of male grafts and of specific T-cell and antibody reactivity against H-Y encoded gene products. By contrast, in kidney transplantation, the role of H-Y as a minor histocompatibility antigen has been disputed. We aimed to investigate whether an immunological H-Y effect occurs in kidney transplantation.
We did a retrospective cohort study between 1985 and 2004 in 195 516 recipients of allografts from deceased donors. We used multivariate statistical methods to compare graft survival and death-censored graft survival rates for female and male donor kidneys in female and male recipients at 1 and 10 years.
Graft loss was more common with kidneys from female donors than with those from male donors (p<0·001) after both 1 and 10 years. Female recipients had a lower rate of graft failure between the end of the first year and the end of the tenth year (p<0·001). Compared with all other combinations of sex, transplantation of male donor kidneys into female recipients was associated with an increased risk of graft failure during the first year (hazard ratio [HR] 1·08, 95% CI 1·03–1·14, p=0·003; death censored HR 1·11, 1·04–1·19, p=0·003) and between 2 and 10 years (HR 1·06, 1·01–1·10, p=0·008; death censored HR 1·10, 1·05–1·16, p<0·001).
H-Y minor histocompatibility affects human kidney transplantation.
Swiss National Research Foundation; University of Heidelberg, Germany; European Leukemia Net.
