Sex-Based Heart Transplant Outcomes After Bridging With Centrifugal Left Ventricular Assist Devices

Abstract

Prior studies demonstrated that female sex is associated with an increased mortality after orthotopic heart transplantation (OHT). The impact of sex on OHT outcomes after bridging with newer-generation durable left ventricular assist devices (LVADs) remains unclear. The United Network for Organ Sharing database was queried to study OHT recipients bridged with a newer-generation LVAD (ie, HeartMate III or HeartWare) between 2010 and 2018. The primary outcome was mortality at 30 and 90-days and 1-year. Secondary outcomes included rates of posttransplant complications. Propensity score matching and Cox multivariable analysis were used to assess comorbidity-adjusted sex differences in outcomes. A total of 3010 patients (76.7% male) bridged with newer-generation LVADs underwent OHT. After adjusting for relevant covariates, both age and heart failure etiology, but not sex, were independent predictors of mortality. In the matched cohorts, sex did not affect posttransplant outcomes, including renal failure, cerebrovascular events, allograft rejection, functional status, or mortality (all P > .05). Survival at 1-year after OHT was 90.5% in males and 92.8% in females (P= .058). Among 3010 OHT recipients, matched females bridged with newer-generation HeartWare or HeartMate III LVADs have comparable posttransplant outcomes compared with males. Furthermore, survival at 1-year follow-up was not affected by sex; instead, it was driven by well-established risk factors including increased age, worse preoperative renal function, and heart failure etiology. These data suggest that considerable progress has been made in mitigating sex differences in heart failure outcomes in the modern era.