Crandall B G, Renlund D G, O'Connell J B, Burton N A, Jones K W, Gay W A, Doty D B, Karwande S V, Lee H R, Holland C
Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, University of Utah Medical Center, Salt Lake City 84132.
J Heart Transplant. 1988 Nov-Dec;7(6):419-23.
To assess differences between male and female recipients after heart transplantation, we retrospectively reviewed 140 consecutive heart transplant recipients (119 males and 21 females) with regard to sex and characteristics before and after transplantation. Before transplantation, fewer female recipients had heart failure on the basis of coronary artery disease (14% versus 56%, p = 0.001), and more females required inotropic agents (71% versus 38%, p = 0.007). Although average follow-up (for females 430 +/- 73 days, range 12 to 1097 days; for males 412 +/- 27 days, range 1 day to 1103 days, mean +/- standard error of the mean), mortality (one female and nine males), and proportion of recipients with infectious complications (48% females and 52% males) did not differ between the groups, female recipients manifested a higher incidence of rejection during the first 4 months (2.39 +/- 0.27 episodes versus 1.67 +/- 0.11 episodes, p = 0.010) and during follow-up (3.24 +/- 0.44 episodes versus 2.20 +/- 0.21 episodes, p = 0.012). Although it was possible to discontinue maintenance dosages of corticosteroids in 65% of males, corticosteroid discontinuation was possible in only 17% of females (p less than 0.001). Furthermore, in a stepwise logistic regression analysis that included age, crossmatch (no female recipients with positive results, three males with positive results), cause of heart failure, and hemodynamic status before transplantation, females were more likely to experience a rejection episode than males (p less than 0.001). Although female recipients experience rejection episodes more than their male counterparts after heart transplantation and are more likely to require maintenance corticosteroid therapy, survival and the incidence of infectious complications are not different.
为评估心脏移植术后男性和女性受者之间的差异，我们回顾性分析了140例连续的心脏移植受者（119例男性和21例女性）的性别及移植前后的特征。移植前，因冠状动脉疾病导致心力衰竭的女性受者较少（14% 对56%，p = 0.001），且更多女性需要使用血管活性药物（71% 对38%，p = 0.007）。尽管平均随访时间（女性为430±73天，范围12至1097天；男性为412±27天，范围1天至1103天，均值±均值标准误）、死亡率（1例女性和9例男性）以及有感染并发症的受者比例（女性48%，男性52%）在两组间无差异，但女性受者在术后前4个月（2.39±0.27次对1.67±0.11次，p = 0.010）及随访期间（3.24±0.44次对2.20±0.21次，p = 0.012）排斥反应的发生率更高。尽管65%的男性受者有可能停用维持剂量的皮质类固醇，但只有17%的女性受者可以停用（p<0.001）。此外，在一项逐步逻辑回归分析中，纳入了年龄、交叉配型（女性受者无阳性结果，3例男性受者阳性）、心力衰竭病因及移植前血流动力学状态，结果显示女性比男性更易发生排斥反应（p<0.001）。尽管心脏移植术后女性受者比男性受者更易发生排斥反应，且更可能需要维持皮质类固醇治疗，但生存率和感染并发症的发生率并无差异。
