Purpose: Although the effects of donor-recipient gender matching on transplant outcomes have been discussed for long, no widely-accepted consensus has been reached. We conducted a meta-analysis to comprehensively reevaluate how gender matching affects transplant outcomes in major organ transplantations.

Methods: PubMed/Medline, Embase, and Cochrane library databases were searched for relevant studies. Twelve studies (174177 patients) for kidney, 3 studies (28812 patients) for liver, and 4 studies (19184 patients) for heart transplantation comparing transplant outcomes between gender match and mismatch groups, or among the four donor to recipient gender pairs were included. The primary outcome were graft and patient survival.

Results: We found it consistent in kidney, heart, liver transplantation that compared with donor/recipient gender match group, donor/recipient gender mismatch was associated with significantly worse 1-, 3-, 5-year graft or patient survival.

However, gender mismatch had no deleterious effects on delayed graft function (DGF) in kidney transplantation. The interaction between donor and recipient gender is responsible for transplant outcomes. Male donor to male recipient pairing is most advantageous for 5-year outcome, while female donor to male recipient pairing have worst prognosis in both kidney and liver transplantation.

Conclusion: Gender matching greatly affects transplant outcomes in major organ transplantation, which should be considered when organs are allocated.

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