The impact of gender on heart transplantation outcomes: a single center experience.

BACKGROUND

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.

METHODS

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)].

RESULTS

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.

CONCLUSIONS

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.