Donor/recipient sex mismatch and survival after heart transplantation: only an issue in male recipients? An analysis of the Spanish Heart Transplantation Registry.
The results of studies on the association between sex mismatch and survival after heart transplantation are conflicting. Data from the Spanish Heart Transplantation Registry. From 4625 recipients, 3707 (80%) were men. The donor was female in 943 male recipients (25%) and male in 481 female recipients (52%). Recipients of male hearts had a higher body mass index (25.9 ± 4.1 vs. 24.3 ± 3.7; P < 0.01), and male donors were younger than female donors (33.4 ± 12.7 vs. 38.2 ± 12.3; P < 0.01). No further relevant differences related to donor sex were detected. In the univariate analysis, mismatch was associated with mortality in men (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.06-1.32; P = 0.003) but not in women (HR, 0.91; 95% CI 0.74-1.12; P = 0.4). A significant interaction was detected between sex mismatch and recipient gender (P = 0.02). In the multivariate analysis, sex mismatch was associated with long-term mortality (HR, 1.14; 95% CI 1.01-1.29; P = 0.04), and there was a tendency toward significance for the interaction between sex mismatch and recipient gender (P = 0.08). In male recipients, mismatch increased mortality mainly during the first month and in patients with pulmonary gradient >13 mmHg. Sex mismatch seems to be associated with mortality after heart transplantation in men but not in women.
Hospital Universitario Gregorio Marañón, Universidad Europea de Madrid, Madrid, Spain.
Manuel
M
Martinez-Selles
Luis
L
Almenar
Maria J
MJ
Paniagua-Martin
Javier
J
Segovia
Juan F
JF
Delgado
Jose M
JM
Arizón
Ana
A
Ayesta
Ernesto
E
Lage
Vicens
V
Brossa
Nicolás
N
Manito
Félix
F
Pérez-Villa
Beatriz
B
Diaz-Molina
Gregorio
G
Rábago
Teresa
T
Blasco-Peiró
Luis
L
De La Fuente Galán
Domingo
D
Pascual-Figal
Francisco
F
Gonzalez-Vilchez
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D009927:Tissue and Organ Procurement / Q000379:methods*; D066027:Transplant Recipients; D055815:Young Adult
gender; heart transplantation; mismatch; sex