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

This study investigates 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. (www.actabiomedica.it).