Influence of donor-recipient gender mismatch on renal function and on pharmacokinetics of tacrolimus after kidney transplantation: A 1-year single-center analysis

Fabrizio D'Anselmi; Filippo Montali; Barbara Binda; Francesco Pisani; Davide Chiappori; Gabriella  Dobrowolny; Matthew S  Garner; Panarese Alessandra

doi:10.23750/abm.v96i2.15925

Influence of donor-recipient gender mismatch on renal function and on pharmacokinetics of tacrolimus after kidney transplantation: A 1-year single-center analysis

Authors

Fabrizio D'Anselmi General and Transplant Surgery Department, San Salvatore Hospital, ASL 1 Abruzzo, Avezzano-Sulmona-L'Aquila, Coppito,L'Aquila, Italy.
Filippo Montali General and Transplant Surgery Department, San Salvatore Hospital, ASL 1 Abruzzo, Avezzano-Sulmona-L'Aquila, Coppito, L'Aquila, Italy. https://orcid.org/0000-0001-8761-0052
Barbara Binda General Surgery Department, Velletri Hospital, ASL Roma 6, Rome, Italy
Francesco Pisani General and Transplant Surgery Department, San Salvatore Hospital, ASL 1 Abruzzo, Avezzano-Sulmona-L'Aquila, Coppito, L'Aquila, Italy.
Davide Chiappori General and Transplant Surgery Department, San Salvatore Hospital, ASL 1 Abruzzo, Avezzano-Sulmona-L'Aquila, Coppito, L'Aquila, Italy.
Gabriella Dobrowolny Laboratory affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, DAHFMO-Unit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy.
Matthew S Garner Wake Forest Baptist Medical Center, Medical Center Boulevard. Winston-Salem, NC. United States
Panarese Alessandra General and Transplant Surgery Department, San Salvatore Hospital, ASL 1 Abruzzo, Avezzano-Sulmona-L'Aquila, Coppito, L'Aquila, Italy.

Keywords:

kidney transplantation, sex-mismatch, donor-recipient, tacrolimus , pharmacokinetics, renal function, immunosuppressive agent, graft function, organ transplantation, gender differences

Abstract

This study investigate whether donor-recipient gender mismatch influences the function of the transplanted kidney and the pharmacokinetics of tacrolimus (TAC) in the first post-transplant year. We carried out a retrospective study on a cohort of 100 transplanted from deceased donors divided into 4 subgroups of 25: subgroup M-M (man with male kidney), F-M (man with female kidney), M-F (woman with male kidney), F-F (woman with female kidney). For each patient were calculated mean and standard deviation of diuresis, eGFR (estimated Glomerular Filtration Rate), MAP (Mean Arterial Pressure), weight, BMI (Body Mass Index), BSA (Body Surface Area), TAC blood concentrations/dose-TAC (C/D ratio) and corticosteroid dose/kg between 0-3 months and between 3-12 months of follow up. Diuresis and MAP are not affected by the mismatch. At 4-12 months the M-M subgroup shows higher eGFR than the other three subgroups while the F-M subgroup has a significantly lower eGFR value than the other male M-M subgroup: eGFRfM=44.46 mL/min/1,73m2 vs eGFRmM=58.11 mL/min/1.73m2. The C/D ratio of TAC identifies the F-M subgroup as the subgroup with the slowest metabolism of TAC. Low eGFR values and TAC 'slow metabolizer' status identify subjects with worse prognosis and greater risk of post-transplant complications. This study demonstrates the influences of gender mismatch on renal clearance and pharmacokinetics of TAC and identifies the F-M subgroup as a subgroup with worse prognosis.

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