title: Impact of donor-recipient sex match on long-term survival after heart transplantation in children: An analysis of 5797 pediatric heart transplants.
abstract: The effect of donor-recipient sex matching on long-term survival in pediatric heart transplantation is not well known. Adult data have shown worse survival when male recipients receive a sex-mismatched heart, with conflicting results in female recipients. We analyzed 5795 heart transplant recipients ≤ 18 yr in the Scientific Registry of Transplant Recipients (1990-2012). Recipients were stratified based on donor and recipient sex, creating four groups: MM (N = 1888), FM (N = 1384), FF (N = 1082), and MF (N = 1441). Males receiving sex-matched donor hearts had increased unadjusted allograft survival at five yr (73.2 vs. 71%, p = 0.01). However, this survival advantage disappeared with longer follow-up and when adjusted for additional risk factors by multivariable Cox regression analysis. In contrast, for females, receiving a sex-mismatched heart was associated with an 18% higher risk of allograft loss over time compared to receiving a sex-matched heart (HR 1.18, 95% CI: 1.00-1.38) and a 26% higher risk compared to sex-matched male recipients (HR 1.26, 95% CI: 1.10-1.45). Females who receive a heart from a male donor appear to have a distinct long-term survival disadvantage compared to all other groups.
authors.affiliation: Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors.forename: Mariska
authors.initials: M
authors.lastname: Kemna
authors.affiliation: Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Albers
authors.affiliation: Core for Biomedical Statistics, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Miranda C
authors.initials: MC
authors.lastname: Bradford
authors.affiliation: Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Law
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors.forename: Lester
authors.initials: L
authors.lastname: Permut
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors.forename: D Mike
authors.initials: DM
authors.lastname: McMullan
authors.affiliation: Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors.forename: Yuk
authors.initials: Y
authors.lastname: Law
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012723:Sex; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
keywords: graft survival; heart transplantation; long-term results; pediatric