Gender Differences in Patients Undergoing Heart Transplantation Using the Database of the United Networks of Organ Sharing

Background: Differences in symptoms, disease course and treatment of heart failure between women and men are known. Possible gender differences in indications, procedural characteristics and outcome of heart transplantation are not well established. We aimed to examine gender aspects in heart transplantation and to identify gender-specific predictors for perioperative outcome.

Methods: From a total of 41,830 first time heart transplant recipients, 22.7% were women. Of the prospective international United Network of Organ Sharing (UNOS) database we examined gender differences in perioperative patient characteristics. We followed patients for all-cause mortality and the incidence of graft failure, allograft vasculopathy, and malignancy. We compared risk of experiencing the aforementioned outcomes between women and men by using age-adjusted Cox regression models (one model per outcome).

Results: At transplant, women were younger than men (median age 52 versus 55 years, p < 0.001) suffered less likely from ischemic cardiomyopathy (7.4% in women versus 18.7% in men, p < 0.001) and were less frequently bridged by mechanical circulatory support (14.5% in women versus 19.6% in men, p < 0.001). Transplant urgency was comparable (status 1A at transplant 23.5% in women versus 25.5% in men, p < 0.001). Patients were observed for a median of 10 years (maximum follow-up time was 26.3 years). We observed 17,937 deaths during follow-up. Survival post heart transplantation was comparable in women and men (hazard ratio (HR) 0.99, 95% confidence interval [0.95, 1.02], p = 0.43). There was a trend for higher graft failure for women (HR 1.08 [0.99, 1.19], p = 0.084) and significantly lower allograft vasculopathy (HR 0.86 [0.82, 0.89], p < 0.001) and malignancy (HR 0.61 [0.57, 0.65], p < 0.001).

Conclusion: In a large, prospective cohort of heart transplant recipients, women and men differed in indication and procedural characteristics for heart transplantation. Overall survival after heart transplantation was comparable, but the incidence of adverse events was different between women and men. Whether the knowledge on gender differences in patient characteristics and gender-specific risk prediction can support clinical decisions and improve outcome, needs to be shown.

No conflict of interest has been declared by the author(s).