Gender differences in heart transplantation: Twenty‐five year trends in the nationwide Spanish heart transplant registry

García‐Cosio, María Dolores; González‐Vílchez, Francisco; López‐Vilella, Raquel; Barge‐Caballero, Eduardo; Gómez‐Bueno, Manuel; Martínez‐Sellés, Manuel; Arizón, José M.; Rangel‐Sousa, Diego; González‐Costello, José; Mirabet, Sònia; Pérez‐Villa, Félix; Molina, Beatriz Díaz; Rábago, Gregorio; Ocampo, Ana Portolés; de, Luis Montes; Galan, la Fuente; Garrido, Iris P.; Jiménez, Juan F. Delgado

doi:10.1111/ctr.14096

Cited by 18 publications

(11 citation statements)

References 38 publications

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“…In our study, women accounted for less than one third of HTx recipients. This sex distribution has also been documented in previous UNOS-and non-UNOS based studies 12,25 and did not change over the last years. 26 This sex disparity might be partly explained by differences in disease course, symptom patterns, delayed clinical presentation, and selection and/or referral bias of patients with advanced HF.…”

Section: Sex Differences In Clinical Characteristicssupporting

confidence: 84%

Sex differences in clinical characteristics and outcomes in patients undergoing heart transplantation

et al. 2023

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Aims 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. Methods and results 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. Conclusions 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.

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Section: Sex Differences In Clinical Characteristicssupporting

confidence: 84%

Sex differences in clinical characteristics and outcomes in patients undergoing heart transplantation

et al. 2023

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“…We, and others, have demonstrated marked differences at all stages of the heart transplant assessment pathway 13–17 . Two of our findings suggest that there is not a systematic bias against female referrals or transplantation: [1] the percentage of females assessed (32%) is very similar to the ratio reported in the UK National Heart Failure audit of hospitalised patients with heart failure (2019/2020 data: 32% 55–64 years; 30% 45–54 years) 1 .…”

Section: Discussionsupporting

confidence: 70%

“…We, and others, have demonstrated marked differences at all stages of the heart transplant assessment pathway. [13][14][15][16][17] Two of our findings suggest that there is not a systematic bias against female referrals or transplantation: [1] the percentage of females assessed (32%) is very similar to the ratio reported in the UK National Heart Failure audit of hospitalised patients with heart failure (2019/2020 data: 32% 55-64 years; 30% 45-54 years). 1 The UK National Heart Failure Audit is a comprehensive audit of all patients in the United Kingdom admitted with heart failure to hospital and so is a comprehensive database, and our best way to look at the issue of community prevalence of heart failure and gender (at least in those that are admitted to hospital); [2] females are more likely to be too well for transplant rather than unsuitable for transplant, suggesting that we are not seeing females too late.…”

Section: 1supporting

confidence: 74%

Gender differences in the assessment, decision‐making and outcomes for ventricular assist devices and heart transplantation: An analysis from a UK transplant center

MacGowan

McDiarmid

Jansen

et al. 2022

Clinical Transplantation

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Purpose There are marked gender differences in all etiologies of advanced heart failure. We sought to determine whether there is evidence of gender‐specific decision making for transplant assessments, and how gender effects outcomes. Methods Retrospective analysis of adult heart transplant assessments at a single UK center between April 2015 and March 2020. Results Females were 32% of referrals (N = 137 females, 285 males), with marked differences between diagnoses – 11% ischemic and 43% of adult congenital. Females were younger, shorter, weighed less, and had lower pulmonary pressures. Females were much less likely to receive a ventricular assist device (13%). Blood type “O” females were relatively more likely compared to males to receive a transplant (45%). Comparing males and females who received a ventricular assist device, both had similar levels of high pulmonary pressures, indicating consistent decision‐making based on hemodynamics to implant a device. Overall survival was better for females (in noncongenital patients), and this was due to female patients who were not accepted for transplant or a ventricular assist device being more often “too well for transplant,” rather than in males when they were more often “unsuitable.” Conclusions Marked gender differences exist at all stages of the heart transplant assessment pathway. Appropriate decision‐making based on clinical grounds is shown with less transplants in male blood type “O”s and hemodynamic criteria for ventricular assist device implantation in both genders. Further studies are needed to determine if there is a wider community bias in advanced heart failure treatments for females.

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“…Our previous work analyzing the Spanish Heart Transplant Registry results over the last 25 years showed a similar survival and similar HT rate in women per million habitants. Causes of death differed between men, mainly due to neoplastic diseases, and women, mainly due to primary graft failure and rejection (18). All the described studies show a comparable pattern of baseline characteristics and underlying heart disease.…”

Section: Discussionmentioning

confidence: 78%

Influence of Gender in Advanced Heart Failure Therapies and Outcome Following Transplantation

García‐Cosio

González‐Vílchez

López‐Vilella

et al. 2021

Front. Cardiovasc. Med.

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Biological differences between males and females change the course of different diseases and affect therapeutic measures' responses. Heart failure is not an exception to these differences. Women account for a minority of patients on the waiting list for heart transplantation or other advanced heart failure therapies. The reason for this under-representation is unknown. Men have a worse cardiovascular risk profile and suffer more often from ischemic heart disease. Conversely, transplanted women are younger and more frequently have non-ischemic cardiac disorders. Women's poorer survival on the waiting list for heart transplantation has been previously described, but this trend has been corrected in recent years. The use of ventricular assist devices in women is progressively increasing, with comparable results than in men. The indication rate for a heart transplant in women (number of women on the waiting list for millions of habitants) has remained unchanged over the past 25 years. Long-term results of heart transplants are equal for both men and women. We have analyzed the data of a national registry of heart transplant patients to look for possible future directions for a more in-depth study of sex differences in this area. We have analyzed 1-year outcomes of heart transplant recipients. We found similar results in men and women and no sex-related interactions with any of the factors related to survival or differences in death causes between men and women. We should keep trying to approach sex differences in prospective studies to confirm if they deserve a different approach, which is not supported by current evidence.

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Gender differences in heart transplantation: Twenty‐five year trends in the nationwide Spanish heart transplant registry

Cited by 18 publications

References 38 publications

Sex differences in clinical characteristics and outcomes in patients undergoing heart transplantation

Sex differences in clinical characteristics and outcomes in patients undergoing heart transplantation

Gender differences in the assessment, decision‐making and outcomes for ventricular assist devices and heart transplantation: An analysis from a UK transplant center

Influence of Gender in Advanced Heart Failure Therapies and Outcome Following Transplantation

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