Sex-Based Differences in Early and Late Kidney Outcomes After Heart Transplantation

Area of Science:

• Nephrology
• Cardiology
• Transplantation Medicine

Background:

• Kidney disease is a known complication following heart transplantation (HT), increasing mortality.
• Limited research exists on sex-based disparities in kidney outcomes after HT.

Purpose of the Study:

• To investigate potential sex-based differences in early and late kidney failure after heart transplantation.
• To compare kidney outcomes before and after the 2018 heart allocation system change.

Main Methods:

• Analysis of adult patients undergoing HT between 2010-2022 from the United Network for Organ Sharing registry.
• Exclusion of multiorgan transplants and patients requiring pre-HT dialysis.
• Utilized multivariable logistic and Cox regression to assess sex as a predictor of early and late kidney failure, respectively.

Main Results:

• Out of 30,414 HT recipients, sex was not a significant predictor of early kidney failure (OR 0.93, P=0.2).
• Early kidney failure rates increased post-2018 allocation system change for both sexes, with similar effects (P-interaction > 0.9).
• No significant sex differences were observed in the time to late kidney failure (log rank P=0.4) or adjusted risk (aHR 1.11, P=0.2) over a median of 5 years.

Conclusions:

• Sex is not a predictor of early or late kidney failure following heart transplantation.
• Further research is warranted to explore sex-specific risk factors and develop targeted preventive strategies for kidney failure post-HT.