Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA 94305, USA.
J Heart Lung Transplant. 2012 May;31(5):459-66. doi: 10.1016/j.healun.2012.02.005. Epub 2012 Mar 13.
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.
先前的研究在分析心脏移植后供体和受体性别与急性排斥反应（AR）和心脏移植血管病（CAV）等死亡原因之间的关系时得出了相互矛盾的结果。我们使用国际心肺移植协会（ISHLT）登记处，这是全球最大的心脏移植结果存储库，全面解决了这些问题。
我们研究了 1990 年至 2008 年间进行的 60584 例成年心脏移植受者。研究的结果是总生存率、死亡风险调整的移植物生存率、AR 和 CAV，使用回归模型进行研究。为了评估供体/受体性别不匹配是否影响结果，通过包含供体和受体性别之间的交互项，比较了男性受者接受女性供体与男性供体与女性受者接受女性供体与男性供体的结果。
在女性供体与男性供体的情况下，女性受者的总生存率和死亡风险调整的移植物生存率与男性受者存在显著差异。与男性受者接受男性供体相比，女性受者接受女性供体的调整死亡率增加了 10%，而女性受者接受男性供体的调整死亡率降低了 10%（p < 0.0001）。在死亡风险调整的移植物生存率方面也发现了类似的结果。供体性别对 AR 或 CAV 的影响在男性和女性受者之间没有显著差异。
对 ISHLT 数据集的分析表明，供体/受体性别不匹配与心脏移植后生存率降低之间存在很强的关联。
