Women more likely to reject a kidney donated by a man.

Transplantation is the ultimate renal replacement therapy, it is more cost effective than dialysis and is associated with a higher quality of life. Both males and females benefit equally from transplantation when appropriate matching is done, donors are matched against recipients by a system that ensures the best possible matches based on the HLA (human leucocyte antigen) system. Patients are not usually matched according to gender, however that may be about to change.
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A recent study by Kim et. al. at the Toronto general Hospital was performed based on previous reports that have suggested that female recipients of male deceased donor kidneys are at increased risk of graft failure because of mismatch of a novel protein known as H-Y. The study has confirmed previous work and given more weight to the notion that female recipients of male donor kidney transplants have an increased risk of rejection.

The risk of rejection occurs within the first year of transplantation and then becomes equal to all other gender matches. Previous reports have suggested a much longer lasting effect. The issue of a longer term effect still remains to be resolved and larger studies with longer follow up periods will be required before any changes are made to the policy guidelines for transplantation.

The mechanism of increased risk within the first year of transplantation is based on a guaranteed mismatch between men and women in the often forgotten minor histo-compatability complex the little brother of the larger major histo-compatability complex or HLA system that is regular checked in routine crossmatching.

The gene products of this minor system have been shown in a few trials to induce organ rejection in animal models as well as human models in other types of transplantation.

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