Published Online
on July 8, 2009

A more recent version of this article appeared on September 1, 2009

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Original Article

The Impact of Donor-Recipient Sex Matching On Survival Following Orthotopic Heart Transplantation – Analysis Of 18,000 Transplants in the Modern Era

Eric S. Weiss¹; Jeremiah G. Allen; Nishant D. Patel; Stuart D. Russell; William A. Baumgartner; Ashish S. Shah and John V. Conte

The Johns Hopkins University Medical Institutions, Baltimore, MD

¹ E-mail: eweiss3{at}jhmi.edu

Background—Single institution series have suggested that males receiving orthotopic heart transplantation (OHT) from female donors have decreased survival. No multi-institutional series has comprehensively addressed the issue of donor and recipient sex matching for both male and female OHT recipients.

Methods and Results—We utilized data from the multi-institutional prospectively collected United Network for Organ Sharing open transplantation cohort to review 18,240 adult patients who received OHT from 1999-2007. Four donor recipient strata were identified (M donor /M recipient, N=10,750, F donor /F recipient, N=2201, M donor /F recipient, N=2121, and F donor / M recipient N=3168). The primary endpoint of all cause post transplant mortality was compared among groups using a Cox proportional hazard regression model with additional propensity adjustment. Female recipients, irrespective of donor sex, had 3.6% lower overall survival at 5 years post transplant (p=0.003). Males who received organs from male donors had the highest cumulative survival at 5 years (74.5%). Males receiving female hearts had a 15% increase in the risk of adjusted cumulative mortality (HR 1.15 [95% CI 1.02-1.30], p=0.02). No significant increase in the relative hazard for death occurred for females receiving opposite sex donor organs (1.24 [92=1.35], p=0.31).

Conclusions—The UNOS dataset has provided a large sample examining donor recipient gender pairing in OHT. Males receiving organs for same sex donors have significantly improved short and long term survival. No survival advantage was seen for females with same sex donors.

Key Words: heart failure • sex • transplantation • UNOS • outcomes

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Circ Heart Fail 2009 2: 389-392. [Extract] [Full Text] [PDF]