De Santo Luca Salvatore, Marra Claudio, De Feo Marisa, Amarelli Cristiano, Romano Gianpaolo, Cotrufo Maurizio
Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, Naples, Italy.
Ital Heart J. 2002 Jul;3(7):419-23.
According to the data of the Registry of the International Society for Heart and Lung Transplantation, donor and recipient female gender is a significant risk factor for mortality after heart transplantation. It has also been reported that donor-recipient gender mismatch is a determinant of post-transplant morbidity and mortality. To examine the effect of gender on the early and mid-term outcomes, we retrospectively reviewed data of a consecutive group of heart transplant recipients at our Institution.
The study population comprised 99 patients undergoing heart transplantation between 1996 and 1998. This population was divided into four groups on the basis of donor and recipient matching. Group A consisted of 61 men who received male donor hearts, group B of 12 women who received female donor hearts, group C of 9 women who received male donor hearts, and group D of 17 men who received female donor hearts. Standard heart transplantation protocols were applied to all patient groups [graft preservation with Celsior solution, Shumway surgical technique, donor-recipient size matching > or = 1.0, induction therapy with polyclonal antithymocyte globulins, triple immunosuppressive therapy (neoral, azathioprine, steroids)].
The study groups were found to be homogeneous with regard to the major preoperative risk factors (etiology, status at transplantation, donor and recipient age, total ischemic time). Donor gender, recipient gender and donor-recipient gender mismatching did not significantly modify the short and mid-term survivals, functional recovery and freedom from rejection.
Even though previous reports suggest that gender negatively affects survival, this factor proved to have no influence on the outcomes of the present series. These results can be explained by a correct donor-recipient size matching. The well-documented female recipients tendency to more frequent and fatal rejection was not confirmed in our experience. The patient's age at transplantation, the routine use of induction therapy and an aggressive immunosuppressive regimen may be the substrate of these findings.
根据国际心肺移植学会登记处的数据，供体和受体均为女性是心脏移植后死亡的一个重要危险因素。也有报道称，供体-受体性别不匹配是移植后发病率和死亡率的一个决定因素。为了研究性别对早期和中期结果的影响，我们回顾性分析了我院一组连续心脏移植受者的数据。
研究人群包括1996年至1998年间接受心脏移植的99例患者。根据供体和受体的匹配情况，将该人群分为四组。A组由61名接受男性供体心脏的男性组成，B组由12名接受女性供体心脏的女性组成，C组由9名接受男性供体心脏的女性组成，D组由17名接受女性供体心脏的男性组成。所有患者组均采用标准的心脏移植方案[用赛而斯溶液保存移植物、舒姆韦手术技术、供体-受体大小匹配≥1.0、用多克隆抗胸腺细胞球蛋白进行诱导治疗、三联免疫抑制治疗（新山地明、硫唑嘌呤、类固醇）]。
研究组在主要术前危险因素（病因、移植时状况、供体和受体年龄、总缺血时间）方面具有同质性。供体性别、受体性别和供体-受体性别不匹配对短期和中期生存率、功能恢复及无排斥反应情况均无显著影响。
尽管先前的报道表明性别对生存率有负面影响，但该因素在本系列研究结果中并未显示出影响。这些结果可以通过供体-受体大小的正确匹配来解释。我们的经验中并未证实有充分记录的女性受者更频繁发生致命性排斥反应的倾向。移植时患者的年龄、诱导治疗的常规使用以及积极的免疫抑制方案可能是这些结果的基础。
