Sex-Based Outcomes of Heart Re-Transplantation: Analysis from UNOS Database

Abstract

<h3>Purpose</h3> Heart re-transplantation (re-HTx) outcomes are thought to more challenging than primary transplants. There is limited information about the impact of sex matching on prognosis in re-HTx. In this study, we aim to elucidate sex-based outcomes of re-HTx using United Network for Organ Sharing (UNOS) database. <h3>Methods</h3> Adult (≧ 18 years) patients undergoing re-HTx from January 2007 and March 2016 were identified from the UNOS database. Demographic data and outcomes were compared on the recipient sex differences. <h3>Results</h3> There were 463 patients and 179 (38.7%) were female. Compared with male, female recipients were younger (p<.0001), smaller body mass index (p=0.013), lower total bilirubin (p<0.001), fewer smokers (p<0.001), more likely to have renal dysfunction (p=0.002), donor gender female (p<.0001) and larger predicted heart mass ratio (p<0.001). The 30-day and one-year mortality was significantly higher in female recipients compared to male (11.3% vs. 5.0%, p=0.012 and 21.3% vs. 16.9 %, p=0.042, respectively). Kaplan-Meier curve showed significantly worse outcome in female donor-female recipients' cohort (Figure). On multivariable cox regression analysis, female donor-female recipients (HR 1.693, 95% CI 1.035-2.768, p=0.036) was a significant factor of 1-year mortality. <h3>Conclusion</h3> The outcome of female recipients for re-HTx is worse than that of male recipients. Female recipients who receive a female donor had a worst outcome.