title: Gender differences in long-term survival post-transplant: A single-institution analysis in the lung allocation score era.
abstract: The purpose of this study was to clarify the significance of recipient gender status on lung transplant outcomes in a large single-institution experience spanning three decades, we analyzed data from all lung transplants performed in our institution since 1986. Kaplan-Meier curves and Cox proportional hazard models were used to evaluate the effect of recipient characteristics on survival and BOS score ≥1-free survival. Logistic regression analysis was used to explore the association of gender with short-term graft function. About 876 lung transplants were performed between 1986 and 2016. Kaplan-Meier survival estimates at 5 years post-transplant for females vs males in the LAS era were 71% vs 58%. In the LAS era, females showed greater unadjusted BOS≥1-free survival than males (35% vs 25%, P=.02) over 5 years. Female gender was the only factor in the LAS era significantly associated with improved adjusted 5-year survival [HR 0.56 (95% CI 0.33, 0.95) P=.03]. Conversely, in the pre-LAS era female gender was not associated with improved survival. Female recipients showed significantly improved survival over 5 years compared to males in the LAS era. A prospective analysis of biologic and immunologic differences is warranted.
authors.affiliation: University of Minnesota Department of Surgery, Minneapolis, MN, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Loor
authors.affiliation: University of Minnesota School of Public Health, Minneapolis, MN, USA.
authors.forename: Roland
authors.initials: R
authors.lastname: Brown
authors.affiliation: University of Minnesota Department of Surgery, Minneapolis, MN, USA.
authors.forename: Rosemary F
authors.initials: RF
authors.lastname: Kelly
authors.affiliation: University of Minnesota School of Public Health, Minneapolis, MN, USA.
authors.forename: Kyle D
authors.initials: KD
authors.lastname: Rudser
authors.affiliation: University of Minnesota Department of Surgery, Minneapolis, MN, USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Shumway
authors.affiliation: University of Minnesota Department of Surgery, Minneapolis, MN, USA.
authors.forename: Irena
authors.initials: I
authors.lastname: Cich
authors.affiliation: University of Minnesota Department of Surgery, Minneapolis, MN, USA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Holley
authors.affiliation: University of Minnesota Department of Surgery, Minneapolis, MN, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Quinlan
authors.affiliation: University of Minnesota Department of Medicine, Minneapolis, MN, USA.
authors.forename: Marshall I
authors.initials: MI
authors.lastname: Hertz
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D008171:Lung Diseases / Q000401:mortality* / Q000601:surgery; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D009927:Tissue and Organ Procurement
keywords: bronchiolitis obliterans syndrome; clinical outcomes; gender; lung transplant; primary graft dysfunction; recipient factors