The impact of gender mismatching on early and late outcomes following heart transplantation

Aims: The role of donor/recipient gender matching on the long-term rejection process and clinical outcomes following heart transplantation (HT) outcomes is still controversial. We aim to investigate the impact of gender matching on early and long-term outcome HT.

Methods and results: The study population comprised 166 patients who underwent HT between 1991 and 2013 and were prospectively followed up in a tertiary referral centre. Early and late outcomes were assessed by the type of donor-recipient gender match (primary analysis: female donor-male recipient [FD-MR, n = 36] vs. male donor-male recipient [MD-MR, n = 109]). Early mortality, need for inotropic support, length of hospital stay, and major perioperative adverse events did not differ between the FD-MR and MD-MR groups. However, the FD-MR group experienced significantly higher rates of early major rejections per patient as compared with the MD-MR group (1.2 ± 1.6 vs. 0.4 ± 0.8; P = 0.001), higher rates of overall major rejections (16 vs. 5.5 per 100 person years; P < 0.05), and higher rate of cardiac allograft vasculopathy (43% vs. 20%; P = 0.01). Kaplan-Meier survival analysis showed that the cumulative probabilities of survival free of rejections and major adverse events were significantly higher in MD-MR group (P = 0.002 and 0.001, respectively). Multivariate analysis showed that FD-MR status was associated with >2.5-fold (P = 0.03) increase in the risk for rejections and with a >3-fold (P = 0.01) increase in the risk for major adverse events during follow-up.

Conclusions: Donor-recipient gender mismatch is a powerful independent predictor of early and late rejections and long-term major adverse events following HT.