Abstract
Purpose It is known that gender mismatch constitutes a risk factor on early and late mortality in heart transplantation (HT). Its effect on the development of complications, such as primary graft dysfunction and cardiac allograft vasculopathy (CAV), has been less described. We aim to determine the impact of gender mismatch and its association with the development of complications such as cellular and/or antibody-mediated rejection (AMR), CAV and conditional survival in HT patients. Methods Between August 1998 and December 2015, 410 adult patients received an orthotopic HT in our Center. Multiorgan transplants and retransplants patients were excluded. A retrospective analysis was performed on 286 patients. The cohort was divided in 3 groups according to the receptor (R) and donor's (D) gender, male (M) or female (F): group 1 (G1): Matching gender, group 2 (G2): Female mismatch (MR/FD), group 3 (G3): male mismatch (FR/MD). Continuous variables were described as median and interquartile range (IQR), and compared with Kruskal-Wallis test. Categorical variables were described in percentages and using chi-square test. Logistic regression analysis was used to recognize associations among variables. Conditional survival was described and compared using the Kaplan-Meier method and LogRank test. Results Median age was 54 (IQR 6), 50 (IQR 13), and 45 years (IQR 25) for groups 1, 2, and 3, respectively. Gender mismatch did not have a correlation with CAV development or CMV reactivation. Female mismatch triples the possibility of having cellular and/or AMR (OR: 3.4; CI95% 1.01-11.3; p=0.05); the male mismatch did not have a significant association in this outcome. Overall mismatch did not affect overall survival in our population (p=0.92). Conclusion In long term follow-up, neither overall survival nor CAV development were impacted by gender mismatch. On the other hand, the female mismatch group presented a higher risk in the development of AMR or cellular rejection.
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