Sex Differences in Mortality Based on United Network for Organ Sharing Status While Awaiting Heart Transplantation

Abstract

Background There are sex-differences in mortality while awaiting heart transplantation and the reason remains unclear. Methods and Results We included all adults in the Scientific Registry of Transplant Recipients placed on the heart transplant active waitlist from 2004–2015. The primary endpoint was all-cause mortality. Multivariable Cox proportional hazards models were performed to evaluate survival by UNOS status at time of listing. Random Survival Forest was used to identify sex-interactions for the competing risk of death and transplantation. There were 33,069 patients (25% women) awaiting heart transplantation. This cohort included 7,681 UNOS Status 1A (26% women), 13,027 UNOS Status 1B (25% women), and 12,361 UNOS status 2 (26% women). During a median follow-up of 4.3 mo, 1,351 women and 4,052 men died. After adjusting for over 20 risk factors, female sex was associated with a significant risk of death among UNOS Status 1A (aHR 1.14, 95% CI 1.01 to 1.29) and UNOS Status 1B (aHR 1.17, 95% CI 1.05–1.30). In contrast, female sex was significantly protective for time to death among UNOS Status 2 (aHR 0.85, 95% CI 0.76 to 0.95). Sex-differences in probability of transplantation were present for every UNOS Status and over 20 sex-interactions were identified for mortality and transplantation. Conclusions When stratified by initial UNOS Status, women had a higher mortality then men as UNOS Status 1 and a lower mortality as UNOS Status 2. With over 20 sex-interactions for mortality and transplantation, further evaluation is warranted to form a more equitable allocation system.

Effectiveness in the performance of organ transplants in the State of Paraná, Brazil

“…However, in the USA, the predominance shown in some studies has been the greater achievement of transplants in women, where demand is fast, and they are more likely to achieve transplantation [17,18].…”

Sex differences in preformed panel‐reactive antibody levels and outcomes in patients undergoing heart transplantation

“…Cox regressions adjusted only for age showed an additional association for mrPRA class I and graft failure (class I HR 1.03, 1.00-1.05, P = 0.042; Table S6). 15,19 Additionally, higher PRA levels could be related to a lower transplant probability. were often admitted to hospital in more advanced heart failure states, 18 possibly too late for listing.…”

“…15 Clear strengths of the analyses are the availability of one of the largest datasets worldwide and a long follow-up with good power to examine sex differences in transplant-related outcomes. However, data quality control is performed by trained specialists to minimize discrepant data or outliers.…”

“…UNOS status was determined as previously described. 15 Due to the registry nature of the study, this project was exempt of the approval of an ethics committee.…”

“…UNOS status was determined as previously described 15. During this time, information about most recent (mr)PRA class I and II and peak (p)PRA class I and II was uniformly entered in the database (before July 2004, PRA classes had not been entered; after March 2015, calculated PRA were entered).…”