Survival Outcomes After Heart Transplantation

Abstract

Background: Currently, women represent <25% of heart transplant recipients. Reasons for this female underrepresentation have been attributed to selection and referral bias and potentially poorer outcomes in female recipients. The aim of this study was to compare long-term posttransplant survival between men and women, when matched for recipient and donor characteristics. Methods and Results: Using the International Society for Heart and Lung Transplantation Registry, we performed descriptive analyses and estimated overall freedom from posttransplant death stratified by sex using Kaplan-Meier survival methods. Male and female recipients were matched according to the Index for Mortality Prediction After Cardiac Transplantation and Donor Risk Index score using 1:1 propensity score matching. The study cohort comprised 34 198 heart transplant recipients (76.3% men, 23.7% women) between 2004 and 2014. Compared with men, women were more likely younger (51 [39–59] versus 55 [46–61] years; P <0.001) and had a different distribution of heart failure etiology ( P <0.001). In general, the prevalence of comorbidities was lower in women than in men. Women were less likely to have diabetes mellitus (19.1% versus 26.2%; P <0.001), hypertension (40.7% versus 47.9%; P <0.001), peripheral vascular disease (2.4% versus 3.3%; P =0.002), tobacco use (36.5% versus 52.3%; P <0.001), and prior cardiovascular surgery (38.6% versus 50.7%; P <0.001). Women were more likely to have a history of malignancy (10.5% versus 5.3%; P <0.001), require intravenous inotropes (41.4% versus 37.2%; P <0.001), and were less likely supported by an intra-aortic balloon pump (3.3% versus 3.8%; P =0.03) or durable ventricular assist device (22% versus 31.5%; P <0.001). Transplanted male recipients had a higher Index for Mortality Prediction After Cardiac Transplantation score (5 [2–7] versus 4 [1–6]; P <0.001). When male and female heart transplant recipients were matched for recipient and donor characteristics, there was no significant survival difference ( P =0.57). Conclusions: Overall survival does not differ between men and women after cardiac transplantation. Women who survive to heart transplantation appear to have lower risk features than male recipients but receive hearts from higher risk donors.

Twenty‐year survival following orthotopic heart transplantation in the United States

“…Our analysis did not find the effects of gender a be significant predictors of long‐term survival, similar to that of previous report 6 . Furthermore, sex‐mismatch was also insignificant.…”

“…Along with these findings, there are few existing pretransplant recipient and/or donor features that have been found to have a long‐term impact on survival. In previous studies, recipient gender, use of prior cardiac assist as a bridge to transplantation, and/or certain donor characteristics, such as traumatic brain injury versus other etiology of death, have not shown to be influential on midterm (5–10 year) survival after OHT 5–8 . However, black race has been shown to have negative association with longer‐term survival 9 .…”

Gender differences in heart transplantation: Twenty‐five year trends in the nationwide Spanish heart transplant registry

“…Heart transplant (HT) is the gold standard of treatment for selected heart failure (HF) patients refractory to optimal therapy with poor prognosis in the absence of significant comorbidities 4–6 . Although much research has been done to study different aspects of HT, gender differences have received little attention so far 7–9 and most studies have mainly addressed donor–recipient matching 10–12 . It is necessary to have reliable information on the differences in HT by gender and to identify gaps in knowledge and needs of prospective studies.…”

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2020

“… 76 , 77 , 78 Currently, female recipients only represent 1 in 4 heart transplants worldwide, and appear to receive hearts from higher risk donors. 79 This has been ascribed to women presenting with end-stage heart failure at an older age, selection, referral bias, and purported poorer outcomes in female recipients. 80 , 81 , 82 Female recipients, however, have significantly higher post-transplant survival than men (median 12.2 years versus 11.4 years, respectively).…”

“…Both concluded that, when matched for recipient and donor characteristics, sex was not a significant variable predicting mortality in early post-operative, constant, or late survival of heart transplantation. 71 , 79 …”