Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
ESC Heart Fail. 2023 Aug;10(4):2596-2606. doi: 10.1002/ehf2.14413. Epub 2023 Jun 20.
Whether sex affects selection for and outcomes after heart transplantation (HTx) remains unclear. We aimed to show sex differences in pre-transplant characteristics and outcomes after HTx.
From 1995 to 2019, 49 200 HTx recipients were prospectively enrolled in the Organ Procurement and Transplantation Network. Logistic regression models were used to evaluate clinical characteristics by sex. Multivariable Cox regression models were fitted to assess sex differences in all-cause mortality, cardiovascular mortality, graft failure, cardiac allograft vasculopathy (CAV), and malignancy. In 49 200 patients (median age 55 years, interquartile range 46-62; 24.6% women), 49 732 events occurred during a median follow-up of 8.1 years. Men were older than women, had more often ischaemic cardiomyopathy (odds ratio [OR] 3.26, 95% confidence interval [CI] 3.11-3.42; P < 0.001), and a higher burden of cardiovascular risk factors, whereas women had less malignancies (OR 0.47, CI 0.44-0.51; P < 0.001). Men were more often treated in intensive care unit (OR 1.24, CI 1.12-1.37; P < 0.001) with a higher need for ventilatory (OR 1.24, CI 1.17-1.32; P < 0.001) or VAD (OR 1.53, CI 1.45-1.63; P < 0.001) support. After multivariable adjustment, men had a higher risk for CAV (hazard ratio [HR] 1.21, CI 1.13-1.29; P < 0.001) and malignancy (HR 1.80, CI 1.62-2.00; P < 0.001). There were no differences in all-cause mortality, cardiovascular mortality, and graft failure between sexes.
In this US transplant registry, men and women differed in pre-transplant characteristics. Male sex was independently associated with incident CAV and malignancy even after multivariable adjustment. Our results underline the need for better personalized post-HTx management and care.
性别的差异是否会影响心脏移植（HTx）后的选择和结果仍不清楚。本研究旨在探讨 HTx 前的特征和 HTx 后的结局是否存在性别差异。
1995 年至 2019 年，49200 例 HTx 受者前瞻性纳入器官获取与移植网络。使用逻辑回归模型评估性别对临床特征的影响。多变量 Cox 回归模型用于评估全因死亡率、心血管死亡率、移植物衰竭、心脏移植物血管病（CAV）和恶性肿瘤的性别差异。在 49200 例患者（中位年龄 55 岁，四分位间距 46-62；24.6%为女性）中，中位随访 8.1 年期间共发生 49732 例事件。男性比女性年龄更大，更常患有缺血性心肌病（比值比[OR]3.26，95%置信区间[CI]3.11-3.42；P<0.001），心血管危险因素负担更重，而女性恶性肿瘤发病率更低（OR 0.47，CI 0.44-0.51；P<0.001）。男性更常在重症监护病房（OR 1.24，CI 1.12-1.37；P<0.001）接受治疗，更需要通气（OR 1.24，CI 1.17-1.32；P<0.001）或 VAD（OR 1.53，CI 1.45-1.63；P<0.001）支持。多变量调整后，男性发生 CAV（风险比[HR]1.21，CI 1.13-1.29；P<0.001）和恶性肿瘤（HR 1.80，CI 1.62-2.00；P<0.001）的风险更高。男性和女性之间的全因死亡率、心血管死亡率和移植物衰竭无差异。
在这项美国移植登记研究中，男性和女性在 HTx 前的特征存在差异。男性的性别是 CAV 和恶性肿瘤的独立危险因素，即使在多变量调整后也是如此。我们的研究结果强调了需要更好地进行个性化 HTx 后管理和护理。
