Sex differences in clinical characteristics and outcomes in patients undergoing heart transplantation
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Sex differences in clinical characteristics and outcomes in patients undergoing heart transplantation. / Kondziella, Christoph; Fluschnik, Nina; Weimann, Jessica; Schrage, Benedikt; Becher, Peter Moritz; Memenga, Felix; Bernhardt, Alexander M; Blankenberg, Stefan; Reichenspurner, Hermann; Kirchhof, Paulus; Schnabel, Renate B; Magnussen, Christina.
In: ESC HEART FAIL, Vol. 10, No. 4, 08.2023, p. 2596-2606.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Sex differences in clinical characteristics and outcomes in patients undergoing heart transplantation
AU - Kondziella, Christoph
AU - Fluschnik, Nina
AU - Weimann, Jessica
AU - Schrage, Benedikt
AU - Becher, Peter Moritz
AU - Memenga, Felix
AU - Bernhardt, Alexander M
AU - Blankenberg, Stefan
AU - Reichenspurner, Hermann
AU - Kirchhof, Paulus
AU - Schnabel, Renate B
AU - Magnussen, Christina
N1 - © 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2023/8
Y1 - 2023/8
N2 - AIMS: Whether sex affects selection for and outcomes after heart transplantation (HTx) remains unclear. We aimed to show sex differences in pre-transplant characteristics and outcomes after HTx.METHODS AND RESULTS: From 1995 to 2019, 49 200 HTx recipients were prospectively enrolled in the Organ Procurement and Transplantation Network. Logistic regression models were used to evaluate clinical characteristics by sex. Multivariable Cox regression models were fitted to assess sex differences in all-cause mortality, cardiovascular mortality, graft failure, cardiac allograft vasculopathy (CAV), and malignancy. In 49 200 patients (median age 55 years, interquartile range 46-62; 24.6% women), 49 732 events occurred during a median follow-up of 8.1 years. Men were older than women, had more often ischaemic cardiomyopathy (odds ratio [OR] 3.26, 95% confidence interval [CI] 3.11-3.42; P < 0.001), and a higher burden of cardiovascular risk factors, whereas women had less malignancies (OR 0.47, CI 0.44-0.51; P < 0.001). Men were more often treated in intensive care unit (OR 1.24, CI 1.12-1.37; P < 0.001) with a higher need for ventilatory (OR 1.24, CI 1.17-1.32; P < 0.001) or VAD (OR 1.53, CI 1.45-1.63; P < 0.001) support. After multivariable adjustment, men had a higher risk for CAV (hazard ratio [HR] 1.21, CI 1.13-1.29; P < 0.001) and malignancy (HR 1.80, CI 1.62-2.00; P < 0.001). There were no differences in all-cause mortality, cardiovascular mortality, and graft failure between sexes.CONCLUSIONS: In this US transplant registry, men and women differed in pre-transplant characteristics. Male sex was independently associated with incident CAV and malignancy even after multivariable adjustment. Our results underline the need for better personalized post-HTx management and care.
AB - AIMS: Whether sex affects selection for and outcomes after heart transplantation (HTx) remains unclear. We aimed to show sex differences in pre-transplant characteristics and outcomes after HTx.METHODS AND RESULTS: From 1995 to 2019, 49 200 HTx recipients were prospectively enrolled in the Organ Procurement and Transplantation Network. Logistic regression models were used to evaluate clinical characteristics by sex. Multivariable Cox regression models were fitted to assess sex differences in all-cause mortality, cardiovascular mortality, graft failure, cardiac allograft vasculopathy (CAV), and malignancy. In 49 200 patients (median age 55 years, interquartile range 46-62; 24.6% women), 49 732 events occurred during a median follow-up of 8.1 years. Men were older than women, had more often ischaemic cardiomyopathy (odds ratio [OR] 3.26, 95% confidence interval [CI] 3.11-3.42; P < 0.001), and a higher burden of cardiovascular risk factors, whereas women had less malignancies (OR 0.47, CI 0.44-0.51; P < 0.001). Men were more often treated in intensive care unit (OR 1.24, CI 1.12-1.37; P < 0.001) with a higher need for ventilatory (OR 1.24, CI 1.17-1.32; P < 0.001) or VAD (OR 1.53, CI 1.45-1.63; P < 0.001) support. After multivariable adjustment, men had a higher risk for CAV (hazard ratio [HR] 1.21, CI 1.13-1.29; P < 0.001) and malignancy (HR 1.80, CI 1.62-2.00; P < 0.001). There were no differences in all-cause mortality, cardiovascular mortality, and graft failure between sexes.CONCLUSIONS: In this US transplant registry, men and women differed in pre-transplant characteristics. Male sex was independently associated with incident CAV and malignancy even after multivariable adjustment. Our results underline the need for better personalized post-HTx management and care.
KW - Humans
KW - Male
KW - Female
KW - Middle Aged
KW - Sex Characteristics
KW - Retrospective Studies
KW - Heart Transplantation/adverse effects
KW - Proportional Hazards Models
KW - Heart Diseases
U2 - 10.1002/ehf2.14413
DO - 10.1002/ehf2.14413
M3 - SCORING: Journal article
C2 - 37339937
VL - 10
SP - 2596
EP - 2606
JO - ESC HEART FAIL
JF - ESC HEART FAIL
SN - 2055-5822
IS - 4
ER -
