Alcoholic Liver Disease (ALD) leads to an estimated 30,910 deaths per year in the United States, for a mortality rate of 9.3/100,000 per year (CDC, 2024). Among patients who undergo liver transplant, recipients of livers from female donors tend to experience worse outcomes and higher rates of post-transplant mortality (Legaz, 2019). In particular, many studies have found that men who receive female donor livers are significantly more likely to experience graft failure than patients with other donor-recipient relationships (Lai, 2018). Little research exists on the relationship between donor sex and post-transplant outcome among individuals with ALD, specifically.

This study examines electronic health record data from a major transplant center in Atlanta, Georgia from the years 2013-2023 to identify the relationship between donor sex and post-transplant survival at 1 and 3 years in patients with Alcoholic Liver Disease. A number of potential covariates, including patient and donor age, donor circumstance of death, patient MELD score, and donor-recipient BMI difference were tested as potential mediators in the relationship between donor sex and survival.

The results of chi-square analysis found that contrary to the literature, female-female transplants performed significantly worse than other donor-recipient pairings, including female-male pairings. Stepwise logistic regression identified significant associations between female-female pairings and donor and recipient age, donor circumstance of death, and diabetes status. These covariates were not significant in explaining mortality rates in other donor-recipient pairing groups.

The existing literature suggests that among all-cause liver transplants, female-male pairings may experience poor outcomes due to a mismatch in estrogen levels between donor and recipient. This study hypothesizes that female-male transplants outperformed female-female transplants in this case due to the role of excessive alcohol consumption on estrogen production among recipients with ALD.