title: The incremental risk of female sex in heart transplantation: a multiinstitutional study of peripartum cardiomyopathy and pregnancy. Cardiac Transplant Research Database Group.
abstract: BACKGROUND
  Controversy remains regarding the reason females seem to be at increased risk for rejection after heart transplantation. Therefore this study was performed to define the effect of a pretransplantation diagnosis of peripartum cardiomyopathy and the effect of previous pregnancy on the outcome (incidence of rejection and death) of females after heart transplantation.
  
  
  METHODS
  In this multiinstitutional study of 3244 adult (greater than 13 years of age) heart transplant recipients, (a) the outcome of 40 females who underwent transplantation for peripartum cardiomyopathy was compared with that of 200 females of childbearing age (13 to 45 years) who underwent transplantation for other indications and (b) the posttransplantation outcome of 543 females with a history of pregnancy was compared with that of 101 nulliparous adult females and 2562 adult males.
  
  
  RESULTS
  The posttransplantation outcome of females with a history of peripartum cardiomyopathy was similar to that of females of childbearing age who underwent transplantation for other indications. However, parous females had a significantly shorter time to first rejection (p < 0.0001) and greater cumulative rejection than nulliparous females or males. By multivariable analysis, the risk factors for cumulative rejection at 1 year were a history of pregnancy (p < 0.0001), younger recipient age (p < 0.0001), induction therapy (p < 0.0001), and the number of human leukocyte antigen-DR mismatches (p = 0.007).
  
  
  CONCLUSIONS
  Our data suggest that it is previous pregnancy, and not sex per se, that is associated with an increased frequency of rejection in females after heart transplantation.
authors.affiliation: Rush Medical College, Chicago, Illinois, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Johnson
authors.forename: D C
authors.initials: DC
authors.lastname: Naftel
authors.forename: R E
authors.initials: RE
authors.lastname: Hobbs
authors.forename: J A
authors.initials: JA
authors.lastname: Kobashigawa
authors.forename: D E
authors.initials: DE
authors.lastname: Pitts
authors.forename: T B
authors.initials: TB
authors.lastname: Levine
authors.forename: D
authors.initials: D
authors.lastname: Tolman
authors.forename: G
authors.initials: G
authors.lastname: Bhat
authors.forename: J K
authors.initials: JK
authors.lastname: Kirklin
authors.forename: R C
authors.initials: RC
authors.lastname: Bourge
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D009202:Cardiomyopathies / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D006084:Graft Rejection / Q000209:etiology* / Q000401:mortality; D016027:Heart Transplantation / Q000401:mortality*; D006650:Histocompatibility Testing; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality / Q000601:surgery*; D011644:Puerperal Disorders / Q000401:mortality / Q000601:surgery*; D012306:Risk; D015996:Survival Rate; D016896:Treatment Outcome