Effect of donor gender on graft survival following orthotopic heart transplantation

Abstract

Outcome for women compared with men following HTX is assumed to be worse. Men who receive a female heart show a worse clinical outcome (48±0.6% vs. 46.2±1% for 10-year survival). Methods: We studied the impact of donor gender on graft survival in 1263 patients with HTX for whom 32.6% of donors were female. Results: Of 229 (18.1%) women transplanted, 146 (63.7%) received a female heart. Women suffered more often from DCM (70.1% vs. 62.7%), NYHA Class IV (37.2% vs. 31.2%) but less often from diabetes (8.7% vs. 16.2%). Women showed a better 10-year survival rate (58% vs. 46%). Clinical outcome in women was better when HTX was performed for DCM compared with ICM and when women were not bridged to HTX by VAD. Gender mortality showed that women died more often due to infection (30.1% vs. 25.8%) and hemorrhage (4.3% vs. 2.9%). However, cause of death could less often be ascribed to rejection (7.5% vs. 10.7%), malignancy (7.5% vs. 8%) and graft failure (26.9% vs. 31.4%). 10-year survival for women was significantly better compared to men (55% vs. 44%); also, 10-year survival was significantly better for women compared to men who had received a female heart (60% vs. 42%). Conclusions: Women receiving female hearts performed best. Women receiving male hearts had an outcome better than men who received male hearts. This may be due to a lower co-morbidity in females and an essential role since a possible advantage of receiving a female heart is lost in men.