title: Beneficial effect of female gender on long-term survival after heart transplantation.
abstract: BACKGROUND
  We aimed to test whether stenotic microvasculopathy affects the more beneficial course in female cardiac transplant recipients.
  
  
  METHODS
  We studied 873 patients (35/151 premenopausal women aged < or =40 years) who underwent primary heart transplantation. In 7750 biopsies harvested within the first posttransplant year endothelial disease and stenotic microvasculopathy were evaluated by light microscopy (Hematoxylin and Eosin). Kaplan-Meier and Cox regression analyses were performed for major cardiac events (MACE; lethal myocardial infarction, sudden cardiac death, graft failure, and cardiac retransplantation).
  
  
  RESULTS
  Stenotic microvasculopathy was found equally in men (38%) and women (39%). Allografts from premenopausal female-to-male transplants more frequently developed endothelial disease (78% vs. 65%; P=0.021) and stenotic microvasculopathy (46% vs. 28%, P=0.024). Beyond the first 5 posttransplant years women presented MACE less often than men, independently of donor gender and stenotic microvasculopathy (P=0.0001). Multivariate regression analysis found women to be at lower risk for MACE (Relative Risk [RR] 0.38; 95% Confidence Interval [CI] 0.17-0.81), whereas stenotic microvasculopathy (RR 2.15; 95% CI 1.42-3.26) and treated diabetes (RR 1.65; 95% CI 1.08-2.52) indicated a higher risk for MACE.
  
  
  CONCLUSIONS
  Stenotic microvasculopathy has prognostic impact on survival of male and female cardiac recipients; however, it does not affect the more beneficial course of women in the long-term follow-up.
authors.affiliation: Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany. hiemann@dhzb.de
authors.forename: Nicola E
authors.initials: NE
authors.lastname: Hiemann
authors.forename: Christoph
authors.initials: C
authors.lastname: Knosalla
authors.forename: Ernst
authors.initials: E
authors.lastname: Wellnhofer
authors.forename: Hans B
authors.initials: HB
authors.lastname: Lehmkuhl
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Rudolf
authors.initials: R
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000473:pathology; D004699:Endocardium / Q000166:cytology / Q000473:pathology*; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation / Q000379:methods*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology*