Sex-Related Temporal Trends in Donor and Recipient Profile and Outcome after Heart Transplantation: Analysis of the ISHLT Registry

Abstract

<h3>Purpose</h3> The complex interactions between recipient and donor risk factors play a critical role in heart transplantation (HT) outcomes, particularly in light of the changing clinical phenotypes of candidates and donors and the continuing improvements and utilization of evidence-based therapies in women. The aim of this study was to explore temporal sex-related changes in recipient and donor features and effect of sex on HT outcomes. <h3>Methods</h3> We performed an analysis of the ISHLT Registry including primary adult HT performed in 1996-2018. We built a multivariable regression model which explored the likelihood of a set of high-risk clinical characteristics (Figure 1A) to be prevalent in earlier vs later years. We treated transplant year as a continuous variable and the analysis was stratified by sex. Interaction terms of recipient sex and each variable were used to identify differences between male and female recipient sex. <h3>Results</h3> Among 86,307 recipients, there were 19,983 women and 66,324 men. The proportion of transplanted women increased from 19% in 1996 to 27% in 2018 (p<0.001). Recipient and donor characteristics changed significantly over time. This change has been similar for both male and female recipients, with the exception of women with diabetes and history of dialysis having lower likelihood of transplant and women with recent infection having higher likelihood of transplant (Figure 1A). A significant reduction in 5-year mortality and 5-year malignancy rate after transplant was seen over the years. There were no significant sex-related differences in the degree of mortality and malignancy improvement (p=NS for interaction with sex, Figure 1B). <h3>Conclusion</h3> The proportion of women receiving HT has increased. Among those transplanted, there does not appear to be significant sex disparities, as evidenced by similar recipient and donor profiles and a similar improvement of survival and post-transplant malignancy rates in both male and female recipients.