Gender differences in long‐term survival post‐transplant: A single‐institution analysis in the lung allocation score era

Abstract

Purpose To clarify the significance of recipient gender status on lung transplant outcomes in a large single institution experience spanning three decades. Methods We analyzed data from all lung transplants performed in our institution since 1986. Kaplan-Meier curves and Cox proportional hazard models were used to evaluate the effect of recipient characteristics on survival and BOS score ≥1-free survival. Logistic regression analysis was used to explore the association of gender with short term graft function. Results 876 lung transplants were performed between 1986 and 2016. Kaplan-Meier survival estimates at 5 years post-transplant for females versus males in the LAS era were 71% versus 58%. In the LAS era females showed greater unadjusted BOS ≥ 1-free survival than males (35% vs 25%, P=0.02] over 5 years. Female gender was the only factor in the LAS era significantly associated with improved adjusted 5 year survival [HR 0.56 (95% CI 0.33, 0.95) P=0.03]. Conversely, in the pre-LAS era female gender was not associated with improved survival. Conclusion Female recipients showed significantly improved survival over 5 years compared to males in the LAS era. A prospective analysis of biologic and immunologic differences is warranted.

Impact of the donor-recipient gender matching on the graft survival from live donors

“…In the pre-lung allocation score era, female gender was not connected with better survival. Female recipients showed considerably improved survival rate over five years compared to males [17]. However, there are some suggestions that the impressive long-term graft survival benefit of male donor-female recipient versus female donor-male recipient, and of male donor-female recipient versus matched groups (male-male, female-female) in transplant, can be resulted from some donor quality and recipient characteristics as the confounding elements [18][19][20].…”

Post‐infectious bronchiolitis obliterans

“…These reports suggest that there would be a different prevalence of this disease in various areas of the world. In Europe and the USA, most cases are secondary to bone marrow and lung transplantations; in the southern cone of South America, main cases are secondary to infections, especially due to AV. As we will discuss later, these differences may be due to the adenovirus serotypes in the different areas and to a genetic predisposition inherent in the local population.…”

The Impact of the donor-recipient gender matching on the graft survival from live donors

“…In the pre-lung allocation score era, female gender was not connected with better survival. Female recipients showed considerably improved survival over five years compared to males (17). However, there are some suggestions that the impressive long-term graft survival benefit of male donor-female recipient versus female donor-male recipient and of male donor-female recipient versus matched groups (male-male, female-female) in transplant can be the result of some donor quality and recipient characteristics as the confounding elements (18)(19)(20).…”