Background: In haematopoietic stem-cell transplantation, male recipients of female grafts have an increased risk of graft-versus-host disease and female recipients have both an increased risk of rejection of male grafts and of specific T-cell and antibody reactivity against H-Y encoded gene products. By contrast, in kidney transplantation, the role of H-Y as a minor histocompatibility antigen has been disputed. We aimed to investigate whether an immunological H-Y effect occurs in kidney transplantation.
Methods: We did a retrospective cohort study between 1985 and 2004 in 195 516 recipients of allografts from deceased donors. We used multivariate statistical methods to compare graft survival and death-censored graft survival rates for female and male donor kidneys in female and male recipients at 1 and 10 years.
Findings: Graft loss was more common with kidneys from female donors than with those from male donors (p<0.001) after both 1 and 10 years. Female recipients had a lower rate of graft failure between the end of the first year and the end of the tenth year (p<0.001). Compared with all other combinations of sex, transplantation of male donor kidneys into female recipients was associated with an increased risk of graft failure during the first year (hazard ratio [HR] 1.08, 95% CI 1.03-1.14, p=0.003; death censored HR 1.11, 1.04-1.19, p=0.003) and between 2 and 10 years (HR 1.06, 1.01-1.10, p=0.008; death censored HR 1.10, 1.05-1.16, p<0.001).
Interpretation: H-Y minor histocompatibility affects human kidney transplantation.