Gender Differences in Pre-Transplant Characteristics and Short-Term Clinical Outcomes Post Heart Transplantation

Abstract

Purpose Women comprise 1 in 4 of all heart transplant (HT) recipients. Sex/gender differences affect cardiovascular disease burden and outcomes with important potential to impact patient care. As an initial step towards developing personalized therapy, we evaluated differences in HT clinical characteristics and outcomes between men and women. Methods A retrospective review was performed of consecutive adult patients who underwent HT at the University of Ottawa Heart Institute (Ontario, Canada) between 2012 and 2016. We determined patient characteristics in women and men at transplant and outcomes post transplant including death, graft function, rejection, infection and hospitalization. Results A total of 121 HT patients were evaluated: 29 (24%) female, mean age 53.6±12.3 years, 39 (32%) for ischemic cardiomyopathy (Table). Compared to men, women had lower body mass index, increased donor-recipient sex mismatch, and higher sensitization. There were no differences in the use or dose of induction or maintenance immunotherapy, however, women received a higher mean dose of Valganciclovir for cytomegalovirus (CMV) prophylaxis: 12.1±4.1 vs. 9.5±4.2 mg/kg/day, p=0.05. Over a mean follow-up of 3.0±1.9 years, there were 12 (10%) deaths, and no difference in survival or graft function between men and women. Compared to men, women had significantly higher rates of infection (62% vs. 41%, p=0.05) and hospitalization for infection (31% vs. 13%, p=0.03). Leukopenia (white cell count Conclusion Clinical characteristics and short-term outcomes post HT differ among women and men. Prospective evaluation and long-term follow-up of larger cohorts are needed to determine strategies to improve care in women following HT.