Donor and recipient mismatch in liver transplantation – time for reconsideration?

Background To find a well-matched donor is crucial for a successful liver transplantation (LT). Several factors such as a matched size, age and type of donation might benefit survival after LT, but the role of donor and recipient gender mismatch (GM) was not yet fully elucidated. Methods This single centre retrospective cohort study included a total of 1146 patients receiving LT at Ajmera transplant centre Toronto from January 2016 to January 2022. We evaluated the influence of donor/recipient age, gender and type of donor on long term survival within a 10-year observation period after LT. Results Liver transplant recipients with gender mismatch (GM+) had a significantly higher 10-year survival rate compared to recipients without gender mismatch (GM-) (p = 0.018). GM significantly influenced survival of liver transplant recipients and favored increased patient survival of female recipients (p < 0.01). Additionally, male recipients of female donors exhibited a significant improved survival compared to those with male donors. Conclusion Donor and recipient GM might not represent a risk factor for an impaired long-term survival after LT. Moreover, the composition of favorable recipient and donor characteristics seem to be the main factors influencing long term survival. Especially, female donor gender was associated with an improved survival of male transplant recipients.