Influence of donor and recipient sex mismatch on heart transplant outcomes : analysis of the ishlt registry

Background—Prior studies have presented contradictory results after analyzing associations between donor and recipient sex on survival after heart transplantation and causes of death such as acute rejection (AR) and cardiac allograft vasculopathy (CAV). We used the ISHLT Registry, the largest repository of heart transplant outcomes worldwide, to comprehensively address these questions. Methods—We studied 60,584 adult recipients of heart transplants performed between 1990 and 2008. Outcomes of interest were overall survival, death-censored allograft survival, AR, and CAV, which were studied using regression models. To assess whether donor: recipient sex mismatch affected outcomes, the experience of male recipients with female versus male donors was compared to that of female recipients with female versus male donors through inclusion of an interaction term between donor and recipient sex. Results—Significant differences were observed between male and female recipients in overall survival and death-censored allograft survival for female versus male donors. Male recipients of female allografts had a 10% increase in adjusted mortality relative to male recipients of male allografts, while female recipients of female allografts had a 10% decrease in adjusted mortality relative to female recipients of male allografts (p<0.0001). Findings were similar for deathcensored allograft survival. There were no significant differences in the effect of donor sex on AR or CAV between male and female recipients. Conclusions—Analysis of the ISHLT data set has demonstrated a strong association between donor: recipient sex-mismatch and reduced survival after heart transplantation. © 2012 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. ADDRESS FOR CORRESPONDENCE: Kiran K. Khush, MD, MAS, Falk CVRC 263, 300 Pasteur Drive, Stanford, CA 94305, USA, Tel: (650) 721-3241, Fax: (650) 725-1599, kiran@stanford.edu. DISCLOSURES: This work was funded by grants from the International Society for Heart and Lung Transplantation and the National Institutes of Health (K23HL091143). There are no relationships with industry. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author Manuscript J Heart Lung Transplant. Author manuscript; available in PMC 2013 May 1. Published in final edited form as: J Heart Lung Transplant. 2012 May ; 31(5): 459–466. doi:10.1016/j.healun.2012.02.005. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript