Department of Medicine, Nephrology Division, Dalhousie University, Halifax, Nova Scotia, Canada.
Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada.
J Heart Lung Transplant. 2024 Jul;43(7):1162-1173. doi: 10.1016/j.healun.2024.03.016. Epub 2024 Mar 24.
Identification of differences in mortality risk between female and male heart transplant recipients may prompt sex-specific management strategies. Because worldwide, males of all ages have higher absolute mortality rates than females, we aimed to compare the excess risk of mortality (risk above the general population) in female vs male heart transplant recipients.
We used relative survival models conducted separately in SRTR and CTS cohorts from 1988-2019, and subsequently combined using 2-stage individual patient data meta-analysis, to compare the excess risk of mortality in female vs male first heart transplant recipients, accounting for the modifying effects of donor sex and recipient current age.
We analyzed 108,918 patients. When the donor was male, female recipients 0-12 years (Relative excess risk (RER) 1.13, 95% CI 1.00-1.26), 13-44 years (RER 1.17, 95% CI 1.10-1.25), and ≥45 years (RER 1.14, 95% CI 1.02-1.27) showed higher excess mortality risks than male recipients of the same age. When the donor was female, only female recipients 13-44 years showed higher excess risks of mortality than males (RER 1.09, 95% CI 1.00-1.20), though not significantly (p = 0.05).
In the setting of a male donor, female recipients of all ages had significantly higher excess mortality than males. When the donor was female, female recipients of reproductive age had higher excess risks of mortality than male recipients of the same age, though this was not statistically significant. Further investigation is required to determine the reasons underlying these differences.
确定女性和男性心脏移植受者死亡率风险的差异可能会促使制定针对特定性别的管理策略。由于全球范围内，所有年龄段的男性死亡率绝对高于女性，因此我们旨在比较女性和男性心脏移植受者的死亡率超额风险（高于普通人群的风险）。
我们分别使用来自 1988 年至 2019 年 SRTR 和 CTS 队列的相对生存模型，并使用 2 阶段个体患者数据荟萃分析进行联合，以比较女性和男性首次心脏移植受者的死亡率超额风险，同时考虑供体性别和受体当前年龄的调节作用。
我们分析了 108918 名患者。当供体为男性时，0-12 岁（相对超额风险（RER）1.13，95%置信区间（CI）1.00-1.26）、13-44 岁（RER 1.17，95%CI 1.10-1.25）和≥45 岁（RER 1.14，95%CI 1.02-1.27）的女性受者的超额死亡风险高于同年龄的男性受者。当供体为女性时，只有 13-44 岁的女性受者的超额死亡风险高于男性（RER 1.09，95%CI 1.00-1.20），尽管差异不显著（p=0.05）。
在男性供体的情况下，所有年龄段的女性受者的超额死亡风险明显高于男性。当供体为女性时，生殖年龄的女性受者的死亡率超额风险高于同年龄的男性受者，但这在统计学上并不显著。需要进一步调查以确定这些差异的原因。
