Donor-recipient sex mismatch portends poor 10-year outcomes in a single-center experience

Several studies have indicated that survival after heart transplantation is affected by donor-recipient sex matching. In most studies, male recipients of a female heart have the poorest survival rates, whereas survival of female recipients is not affected by donor sex. The purpose of the current study was to determine the long-term outcomes of recipients at a large single center on uniform immunosuppression therapy in the current era.

We reviewed the records of 857 patients transplanted at a single center between 1994 and 2008. Patients were divided into 4 groups based on donor-recipient sex: male donor to male recipient (male/male, n = 506); female donor to female recipient (female/female, n = 113); male donor to female recipient (male/female, n = 106); and female donor to male recipient (female/male, n = 132). Ten-year outcomes were assessed for: survival; freedom from cardiac allograft vasculopathy (CAV); and freedom from non-fatal major adverse cardiac events (NF-MACE).

Ten-year actuarial survival was comparable in male/male and female/female groups, at 69% and 71%, respectively (p > 0.05). Compared with the male/male group, 10-year actuarial survival was significantly lower in the sex-mismatch groups: 58% in the male/female group (p = 0.03) and 59% in the female/male group (p = 0.01). There was no significant difference in 10-year freedom from CAV or NF-MACE among the groups.

Heart transplant patients with donor-recipient sex mismatch have lower survival, extending the results of prior studies to suggest that sex mismatch is undesirable in female, as well as male, recipients. This may impact donor selection and recipient wait time to transplantation.