Impact of Sex-Mismatch on Heart Transplantation: A Meta-Analysis and Systematic Review

Introduction: Limited research has explored heart transplantation (HT) outcomes in patients with sex-mismatched organ donors and recipients. Findings on which type of sex-mismatch has worse post-transplant outcomes have been contradictory. Methods: We searched Medline, Embase, Scopus and Cochrane for publications reporting HT outcomes according to donor/recipient sex mismatch through May 2017. Sex mismatched HT male recipients were compared to non-mismatched male recipients, and sex mismatched HT female recipients were compared to non-mismatched female recipients. Outcomes were compared under the random-effects model and heterogeneity examined via Chi2 and I2 statistics. Sensitivity analyses were performed. Results: A total of 8 studies including 110211 patients were included in the analysis. Of these, 80% were male recipients and 29% had sex-mismatched transplants. In male recipients, sex mismatch was associated with a higher rate of rejection (OR 1.25; 95% CI 1.19-1.32; pu003c0.00001). In female recipients,...