title: The impact of gender mismatching on early and late outcomes following heart transplantation.
abstract: OBJECTIVE
  The role of donor/recipient gender matching on the long-term rejection process and clinical outcomes following heart transplantation (HT) outcomes is still controversial. We aim to investigate the impact of gender matching on early and long-term outcome HT.
  
  
  RESULTS
  The study population comprised 166 patients who underwent HT between 1991 and 2013 and were prospectively followed up in a tertiary referral centre. Early and late outcomes were assessed by the type of donor-recipient gender match (primary analysis: female donor-male recipient [FD-MR,n= 36] vs. male donor-male recipient [MD-MR,n= 109]). Early mortality, need for inotropic support, length of hospital stay, and major perioperative adverse events did not differ between the FD-MR and MD-MR groups. However, the FD-MR group experienced significantly higher rates of early major rejections per patient as compared with the MD-MR group (1.2 ± 1.6 vs. 0.4 ± 0.8;P= 0.001), higher rates of overall major rejections (16 vs. 5.5 per 100 person years;P< 0.05), and higher rate of cardiac allograft vasculopathy (43% vs. 20%;P= 0.01). Kaplan-Meier survival analysis showed that the cumulative probabilities of survival free of rejections and major adverse events were significantly higher in MD-MR group (P= 0.002 and 0.001, respectively). Multivariate analysis showed that FD-MR status was associated with >2.5-fold (P= 0.03) increase in the risk for rejections and with a >3-fold (P= 0.01) increase in the risk for major adverse events during follow-up.
  
  
  CONCLUSIONS
  Donor-recipient gender mismatch is a powerful independent predictor of early and late rejections and long-term major adverse events following HT.
authors.affiliation: Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael; Heart Failure Institute, Heart Center, Sheba Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael.
authors.forename: Yael
authors.initials: Y
authors.lastname: Peled
authors.affiliation: Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Lavee
authors.affiliation: Heart Failure Institute, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Arad
authors.affiliation: Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel.
authors.forename: Yedida
authors.initials: Y
authors.lastname: Shemesh
authors.affiliation: Heart Rehabilitation Center, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Katz
authors.affiliation: Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Kassif
authors.affiliation: Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Asher
authors.affiliation: Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Elian
authors.affiliation: Heart Transplantation Unit, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel.
authors.forename: Yedael
authors.initials: Y
authors.lastname: Har-Zahav
authors.affiliation: Heart Rehabilitation Center, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Heart Failure Institute, Heart Center, Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel.
authors.forename: Dov
authors.initials: D
authors.lastname: Freimark
keywords: Cardiac allograft vasculopathy; Donor; Endomyocardial biopsies; Heart transplantation; Recipient