Mortality, rehospitalization, and post-transplant complications in gender-mismatched heart transplant recipients

Abstract

Background: Limited research has been published on outcomes in heart transplant (HT) recipients with gender-mismatched donors.

Objective: Compare 3-year post-transplant outcomes in 2 groups of gender-mismatched HT recipients and a no-mismatch group.

Methods: Sample: 347 HT recipients: 21.3% (74) received a heart from the opposite gender: Group 1: same gender donor/recipient (273, 78.7%); Group 2: female donor/male recipient (40, 11.5%); Group 3: male donor/female recipient (34, 9.8%).

Outcomes: mortality, hospitalization, and complications.

Results: Female patients with male heart donors had shorter 3-year survival, were rehospitalized more days after HT discharge, and had more treated acute rejection episodes and cardiac allograft vasculopathy. No differences were found in: HT length of stay, respiratory failure, stroke, cancer, renal dysfunction, steroid-induced diabetes, number of IV-treated infections, or the timing of infection and rejection.

Conclusion: Female HT recipients with male donors had worse 3-year outcomes as compared to male-mismatch and no-mismatch groups.

Keywords: Female-mismatched cardiac allograft vasculopathy; Female-mismatched heart transplant outcomes; Female-mismatched heart transplant rehospitalization; Female-mismatched heart transplant rejection; Female-mismatched heart transplant survival; Heart transplant gender-mismatch.

Figure 1

Flow chart depicting the evolution of the heart transplant (HT) sample from enrollment in the study to 3 years after surgery.

Figure 2

Kaplan-Meier survival curves for the first 3 years after heart transplant surgery by donor/recipient gender group (N = 347), indicating shorter survival in Group 3 (female-mismatch: male donor/female recipient). Mean number of days survived: Group 1 (no-mismatch): 928 ± 22 days; Group 2 (male-mismatch): 879 ± 67 days; Group 3 (female-mismatch): 795 ± 69 days. Log rank tests significant: Group 3 (female-mismatch) vs Group 1 (no-mismatch): P = .004; Group 3 (female-mismatch) vs Group 2 (male-mismatch): P = .025.