Abstract 16802: Gender Match Does Not confer Survival Advantage in Pediatric Heart Transplantion

Abstract

Background: In adult heart transplant recipients, a survival advantage for male recipients with donor-recipient gender match has been shown. We determined if similar effects of recipient gender, donor gender, and donor-recipient mismatch exist in pediatric heart transplantation. Methods: We reviewed the United Network for Organ Sharing (UNOS) database for 3630 first time heart transplant recipients younger than age eighteen years transplanted between January 1994 and May 2008. We determined mortality rates based on recipient gender, donor gender, and donor recipient gender match with and without adjustment for known risk factors, including presence of congenital heart disease, assist device, race, donor or recipient age, era, elevated bilirubin or creatinine, mechanical ventilation, and dialysis. Results: Female recipients (F) had increased mortality compared to male recipients (M) with adjusted hazard ratio (HR) = 1.27 (1.12-1.44, p < .001). Donor gender had no effect on mortality. Gender mismatch conferred no survival disadvantage for male recipients with adjusted HR = 1.09 (0.92-1.29, p= .330) nor female recipients with HR= 1.12 (0.93-1.36, p=0.330). The largest survival effect was between M to M and M to F groups (HR=1.38; 1.17-1.63, p< .001). However, 5 year conditional survival was similar between all groups (M to M, F to F, M to F, F to M) (log rank p =.1077 for 30 day and p=.0595 for 1 year survivors). Conclusion: In pediatric heart transplant recipients, unlike adult patients, gender match does not confer survival advantage. Female recipients have increased mortality compared to male recipients. Gender specific recipient risk factors post transplant should be investigated.