Male heart transplant patients survive longer with male donor hearts
MedWire News: Male heart failure patients who receive an orthotopic heart transplantation from a female donor face a 15% greater mortality risk than their peers who receive a male donor heart, study findings show.
The mortality of female recipients was not influenced by the gender of the donor, although they did face a slightly lower survival than men overall, report study co-author John Conte (Johns Hopkins Hospital, Baltimore, Maryland) and colleagues in the journal Circulation, Heart Failure.
There are several potential mechanisms through which donor/ recipient gender mismatch might affect outcomes in transplantation. Chief among these are the presence of the minor histocompatability antigen on the Y chromosome in men, antigen development during normal pregnancy in women, and differing hormonal composition between the genders.
In addition, it is known that female hearts are smaller than men’s and size discrepancy has emerged as an important consideration in orthotopic transplants.
Despite these potential issues, there has only been handful of small single center studies addressing the issue.
To investigate Conte and colleagues prospectively assessed 18,240 adult patients on the United Network for Organ Sharing database who underwent orthotopic heart transplantation from 1999 to 2007.
Four donor-recipient groups were identified: male donor/male recipient (n=10,750); female donor/female recipient (n=220); male donor/female recipient (n=2121); and female donor/male recipient (n=3168).
Female recipients had a significantly lower overall survival than male recipients 5 years after transplant irrespective of donor gender at 70.1% versus 73.7%.
Men who received organs from male donors had the highest cumulative survival at 5 years (74.5%). But men receiving female hearts had a 15% increase in the risk for adjusted cumulative mortality (hazard ratio=1.15).
No significant increase in the relative hazard for death occurred for women receiving opposite sex donor organs.
In an accompanying editorial Jennifer Matthews and Keith Aaronson (University of Michigan, Ann Arbor, USA) agreed with Conte et al’s advice that “men should receive hearts from male donors when feasible,” but said the decision should be taken in context of other risks.
“An ischemic (versus nonischemic) heart failure etiology, a prior transfusion history, and receipt of a compatible but nonidentical ABO group heart are independently associated with 16%, 19%, and 25% higher risks for death in the first year posttransplant.
“Given the multiplicity of donor and recipient factors that influence posttransplant outcomes, a rational response to a single donor or recipient factor should be made.”
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