The Effect of Gender and Gender Match on Mortality in Pediatric Heart Transplantation

Abstract

The effect of organ–recipient gender match on pediatric heart transplant mortality is unknown. We analyzed the effects of gender and donor–recipient gender matching. Based on Organ Procurement and Transplant Network data, we performed a historical cohort study in a population of 3630 heart transplant recipients less than 18 years old. We compared unadjusted and adjusted mortality by recipient gender, donor gender and between gender‐matched and gender‐mismatched recipients. Female recipients had decreased survival compared to male recipients (unadjusted hazard ratio [HR] 1.16, confidence interval [CI] 1.02–1.31; p = 0.020). Organ–recipient gender mismatch did not affect mortality for either male or female recipients, though gender‐mismatched females had the worst survival compared to gender‐matched males, who had the best survival (unadjusted HR 1.26, CI 1.07–1.49; p = 0.005). After adjustment for other risk factors affecting transplant mortality, female recipients had decreased survival compared to male recipients (HR 1.27, CI 1.12–1.44; p = 0.020) and gender matching had no effect. In conclusion, gender mismatch alone did not increase long‐term mortality for pediatric heart transplant recipients. However, there may be additive effects of gender and gender matching affecting survival. There are insufficient data at this time to support that recipient and donor gender should affect heart allocation in children.

Donor–recipient height ratio and outcomes in pediatric heart transplantation

“…Female gender was also a risk factor for five‐yr adjusted mortality. These observations confirm findings of prior adult and pediatric studies about the small but repeatedly observed survival disadvantage and higher risk of severe rejection in female recipients that cannot be thoroughly explained by size mismatching.…”

Donor predictors of allograft utilization for pediatric heart transplantation

“…However, a recent report from Tosi et al . looking at the effect of gender and gender mismatch on pediatric heart transplant outcomes found that while female recipients had overall worse outcomes, the donor gender itself did not have any significant effect on survival for male or female recipients.…”

Volumetrics and fit assessments for donor to recipient size matching in pediatric heart transplantation: Is it time for a new paradigm?

“…Providers will evaluate immunocompatibility, potential implications of sex matching, recipient characteristics such as pulmonary hypertension and the donor‐recipient size match. In pediatrics, unlike in adult heart transplantation, sex mismatch has not been found to significantly affect outcomes . There are also emerging data suggesting that the historical preference for larger donors for recipients with elevated pulmonary pressures may not be justified .…”