Influence of donor and recipient sex on outcomes following simultaneous pancreas–kidney transplantation in the new millennium: Single‐center experience and review of the literature

INTRODUCTION: The influence of sex on outcomes following simultaneous pancreas–kidney transplantation (SPKT) in the modern era is uncertain. METHODS: We retrospectively studied 255 patients undergoing SPKT from 11/2001 to 8/2020. Cases were stratified according to donor (D) sex, recipient (R) sex, 4 D/R sex categories, and D/R sex‐matched versus mismatched. RESULTS: D‐male was associated with slightly higher patient (p = .08) and kidney (p = .002) but not pancreas (p = .23) graft survival rates (GSR) compared to D‐female. There were no differences in recipient outcomes other than slightly higher pancreas thrombosis (8% R‐female vs. 4.2% R‐male, p = .28) and early relaparotomy rates in female recipients (38% R‐female vs. 29% R‐male, p = .14). When analyzing the 4 D/R sex categories, the two D‐male groups had higher kidney GSRs compared to the two D‐female groups (p = .01) whereas early relaparotomy and pancreas thrombosis rates were numerically higher in the D‐female/R‐female group compared to the other three groups. Finally, there were no significant differences in outcomes between sex‐matched and sex‐mismatched groups although overall survival outcomes were lower with female donors irrespective of recipient sex. CONCLUSIONS: The influence of D/R sex following SPKT is subject to multiple confounding issues but survival rates appear to be higher in D‐male/R‐male and lower in D‐female/R‐male categories.