Sex and Gender Issues in Heart Transplantation

Abstract

Heart transplantation (HTx) continues to be the accepted therapy for end-stage heart failure (HF). Although morbidity and mortality continue to decrease, limited donor availability has led to an increase in waiting list times and increases in waiting list mortality [1]. Little attention has been focused on gender differences in post-heart transplant outcomes. Women continue to be underrepresented in clinical trials, and more HF-related deaths occur annually in women as compared to men [2,3]. The fact remains that women are transplanted less frequently than men, making it critical for researchers to examine why such gender differences continue to exist [4,5]. In addition, men are more frequently recipients, whereas women are more frequently donors [4].In a data set of 698 consecutive patients with idiopathic non-ischaemic dilated cardiomyopathy (DCM) referred for HTx to the German Heart Institute, only 15.6% were women, suggesting a referral bias against women. Women were more frequently in NYHA functional class III-IV, had lower exercise tolerance, lower respiratory efficiency, and poorer kidney function but less commonly diabetic than men [6]. Thus, women were referred at a more advanced disease state and relative contraindications such as diabetes appear to be taken more seriously in women [6]. In Spain, women are more likely to be younger, to have a diagnosis of idiopathic dilated