Similar Long-term Survival in Men and Women Despite Lower Risk Profile in Women in the Contemporary Heart Transplantation Era

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Background Women continue to be under-represented as heart transplant (HT) recipients. Past studies on survival rates following HT and gender have suggested conflicting data. We compare long-term survival between male and female HT recipients in the contemporary heart transplantation era from 2000-2018 using novel methods. Methods We identified adult HT recipients between 2000 and 2018 in the Scientific Registry of Transplant Recipients. Men and women were matched using overlap propensity score weighting. We compared 10-year survival with the Kaplan-Meier method. We constructed doubly-robust Cox proportional hazards regression models to determine the risk-adjusted influence of gender on survival. Models were adjusted for recipient and donor characteristic including IMPACT score and donor-recipient predicted heart mass (PHM) ratio. The proportionality assumption was tested by inspection of Shoenfeld residuals with covariates being converted to time-varying if significant. Results We included 36,606 HT recipients. When compared with men, women tended to be younger, have fewer comorbidities, higher PRA, larger IMPACT score and donor-recipient PHM ratio. Unadjusted 10-year estimated survival was similar between men and women (Figure). After risk-adjustment, women had a similar risk of 10-year survival than men (HR 0.94, 95% CI 0.82-1.02; p=0.0974). When comparing between men and women at 1 (p Conclusions In this contemporary cohort of HT recipients, women had similar long-term survival to men despite an overall lower risk profile and greater likelihood to receive a size mismatched heart.