Article

Influence of donor and recipient sex mismatch on heart transplant outcomes: Analysis of the International Society for Heart and Lung Transplantation Registry

Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA 94305, USA.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation (Impact Factor: 5.61). 03/2012; 31(5):459-66. DOI: 10.1016/j.healun.2012.02.005
Source: PubMed

ABSTRACT 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 International Society for Heart and Lung Transplantation (ISHLT) Registry, the largest repository of heart transplant outcomes worldwide, to comprehensively address these questions.
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 vs male donors was compared with that of female recipients with female vs male donors through inclusion of an interaction term between donor and recipient sex.
Significant differences were observed between male and female recipients in overall survival and death-censored allograft survival for female vs male donors. Male recipients of female allografts had a 10% increase in adjusted mortality relative to male recipients of male allografts, whereas 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 death-censored allograft survival. Differences in the effect of donor sex on AR or CAV between male and female recipients were not significant.
Analysis of the ISHLT data set has demonstrated a strong association between donor/recipient sex mismatch and reduced survival after heart transplantation.

0 Followers
 · 
102 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cardiac allograft vasculopathy (CAV) is one of the main causes of late-stage heart failure after heart transplantation. CAV is characterized by concentric luminal narrowing of the coronary arteries, but the exact pathogenesis of CAV is still not unraveled. Many researchers show evidence of an allogeneic immune response of the recipient, whereas others show contrasting results in which donor-derived cells induce an immune response against the graft. In addition, fibrosis of the neo-intima can be induced by recipient-derived circulating cells or donor-derived cells. In this review, both donor and recipient sides of the story are described to obtain better insight in the pathogenesis of CAV. Dual outcomes were found regarding the contribution of donor and recipient cells in the initiation of the immune response and the development of fibrosis during CAV. Future research could focus more on the potential synergistic interaction of donor and recipient cells leading to CAV.
    Journal of Cardiovascular Translational Research 02/2015; 8(2). DOI:10.1007/s12265-015-9612-x · 2.69 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The evaluation of organ donors is of critical importance in all areas of solid organ transplantation. Donor characteristics have been shown to have robust effects on heart transplant recipient outcomes, and evaluation of the donor for suitability for heart transplantation is therefore very comprehensive. The donor evaluation process is composed of several steps, beginning with the identification of a potential organ donor and ending with the transplantation of a donor heart. The purpose of this review is to dissect the complex process of donor evaluation into its component steps, and to highlight the diverse approaches used by transplant clinicians around the world to optimize outcomes at each step. We provide a summary of donor characteristics that have been associated with increased recipient mortality, and discuss areas of uncertainty. Recent additions to the literature present novel insights and solutions to vexing problems in donor evaluation, such as how to make a more accurate assessment of allograft quality. Continued advancement in the evaluation of donors is essential to maintain heart transplantation as a viable therapy that provides excellent long-term survival for patients with end-stage heart failure.
    The Journal of Heart and Lung Transplantation 11/2014; 33(11). DOI:10.1016/j.healun.2014.05.002 · 5.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We intended to evaluate the influence of sex mismatch between donor and recipient, which is still under much debate, on survival and comorbidities after cardiac transplantation. From November 2003 through December 2013, a total of 258 patients were transplanted in our Center. From these, 200 receptors were male (77.5%) and constituted our study population, further divided into those who received the heart from a female donor [Group A] – 44 patients (22%) and those who received it from a male donor [Group B] – 156 (78%). Median follow-up was 4.2±3.0years (1-10 years). The two groups were quite comparable with each other, except for body mass index, systolic pulmonary artery pressure and transpulmonary gradient, which were significantly lower in Group A. A low donor/recipient weigh ratio (<0.8) was avoided whenever possible. Hospital mortality was not different in the two groups. During follow-up, global survival was similar, as was survival free from acute cellular rejection and cardiac allograft vasculopathy. However, patients in group A had decreased survival free from serious infections and malignant tumors. Allocation of female donors to male receptors can be done safely, at least in receptors without pulmonary hypertension and when an adequate donor/recipient weigh ratio is ensured.This article is protected by copyright. All rights reserved.
    Transplant International 08/2014; 27(12). DOI:10.1111/tri.12432 · 3.16 Impact Factor