Background:Currently, women represent <25% of heart transplant recipients. Reasons for this female underrepresentation have been attributed to selection and referral bias and potentially poorer outcomes in female recipients. The aim of this study was to compare long-term posttransplant survival between men and women, when matched for recipient and donor characteristics.Methods and Results:Using the International Society for Heart and Lung Transplantation Registry, we performed descriptive analyses and estimated overall freedom from posttransplant death stratified by sex using Kaplan-Meier survival methods. Male and female recipients were matched according to the Index for Mortality Prediction After Cardiac Transplantation and Donor Risk Index score using 1:1 propensity score matching. The study cohort comprised 34 198 heart transplant recipients (76.3% men, 23.7% women) between 2004 and 2014. Compared with men, women were more likely younger (51 [39–59] versus 55 [46–61] years; P<0.001) and had a different distribution of heart failure etiology (P<0.001). In general, the prevalence of comorbidities was lower in women than in men. Women were less likely to have diabetes mellitus (19.1% versus 26.2%; P<0.001), hypertension (40.7% versus 47.9%; P<0.001), peripheral vascular disease (2.4% versus 3.3%; P=0.002), tobacco use (36.5% versus 52.3%; P<0.001), and prior cardiovascular surgery (38.6% versus 50.7%; P<0.001). Women were more likely to have a history of malignancy (10.5% versus 5.3%; P<0.001), require intravenous inotropes (41.4% versus 37.2%; P<0.001), and were less likely supported by an intra-aortic balloon pump (3.3% versus 3.8%; P=0.03) or durable ventricular assist device (22% versus 31.5%; P<0.001). Transplanted male recipients had a higher Index for Mortality Prediction After Cardiac Transplantation score (5 [2–7] versus 4 [1–6]; P<0.001). When male and female heart transplant recipients were matched for recipient and donor characteristics, there was no significant survival difference (P=0.57).Conclusions:Overall survival does not differ between men and women after cardiac transplantation. Women who survive to heart transplantation appear to have lower risk features than male recipients but receive hearts from higher risk donors.

中文翻译：

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心脏移植后的生存结果：接受性是否重要？

背景：目前，女性仅占心脏移植接受者的25％。女性代表人数不足的原因归因于选择和推荐偏见以及女性接受者的潜在不良结果。这项研究的目的是比较男性和女性在移植后的长期存活情况，以匹配受体和供体的特征。方法和结果：我们使用国际心脏和肺移植协会进行了描述性分析，并从中评估了总体自由度。使用Kaplan-Meier生存方法按性别分层的移植后死亡。男性和女性接受者根据心脏移植后的死亡率预测指数和供体风险指数得分（使用1：1倾向得分匹配）进行匹配。P <0.001），并具有不同的心力衰竭病因分布（P <0.001）。通常，女性合并症的患病率低于男性。妇女患糖尿病的可能性较小（19.1％对26.2％；P <0.001），高血压（40.7％对47.9％；P <0.001），周围血管疾病（2.4％对3.3％；P = 0.002），吸烟（36.5％对52.3％；P <0.001）和先前的心血管外科手术（38.6％对50.7％; P <0.001）。女性更容易有恶性病史（10.5％对5.3％；P <0.001），需要静脉内正性肌力药物（41.4％对37.2％；P<0.001），并且不太可能由主动脉内球囊泵（3.3％对3.8％；P = 0.03）或耐用的心室辅助装置（22％对31.5％；P <0.001）进行支持。移植男性接受者的心脏移植后死亡率预测指数更高（5 [2–7]比4 [1–6]；P <0.001）。当将男性和女性心脏移植接受者的接受者和供者特征进行匹配时，生存率没有显着差异（P = 0.57）。结论：心脏移植后男女的总体生存率没有差异。接受心脏移植手术的女性似乎比男性接受者具有较低的风险特征，但会从较高风险的捐献者那里获得心脏。