Impact of Donor and Recipient Sex-Mismatch in Donation After Circulatory Death Heart Transplant

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-09-02 DOI:10.1111/ctr.70285

Kavya Rajesh, Iris Feng, Farhana Latif, Gabriel Sayer, Nir Uriel, Yuji Kaku, Yoshifumi Naka, Paul Kurlansky, Koji Takeda

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引用次数: 0

Abstract

Background

Prior studies have demonstrated an association between donor/recipient sex mismatch and worse outcomes in donation after brain death (DBD) heart transplant. This study aims to determine the impact of donor/recipient sex mismatch on outcomes in donation after circulatory death (DCD) transplant.

Methods

The study cohort consisted of 1260 patients from the United Network for Organ Sharing (UNOS) dataset who underwent DCD heart transplant between 12/2019 and 12/2023. Transplants were stratified into four groups: female donor/female recipient (FD/FR), female donor/male recipient (FD/MR), male donor/male recipient (MD/MR), and male donor/female recipient (MD/FR). The primary outcomes were acute rejection and post-operative complications, while the secondary outcome was mortality. Multivariable logistic regression was used to analyze factors associated with rejection, while Kaplan–Meier (KM) survival analyses were compared using the log-rank test with post-hoc binary comparisons.

Results

Female recipients who received DCD transplant had higher rates of acute rejection compared to male recipients (FD/FR: 26 (20%), MD/FR: 28 (22.2%), MD/MR 110 (11.8%), FD/MR 6 (9%), p = 0.001) while rates of stroke, dialysis, and pacemaker implantation were similar. Among male recipients, weight, height, and left ventricular assist device (LVAD) were associated with acute rejection. However, neither weight nor height was associated with acute rejection in female recipients. The KM curve showed no difference in long-term mortality.

Conclusions

Female recipients who receive DCD hearts from male and female donors have an increased risk of acute rejection compared to their male counterparts. Height and weight are associated with acute rejection in male patients. Male and female recipients have similar long-term mortality.

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供体和受体性别不匹配对循环死亡心脏移植后捐赠的影响

先前的研究表明，供体/受体性别不匹配与脑死亡（DBD）心脏移植后捐赠的不良结果有关。本研究旨在确定供体/受体性别不匹配对循环死亡（DCD）移植后捐赠结果的影响。研究队列包括1260名来自联合器官共享网络（UNOS）数据集的患者，这些患者在2019年12月至2023年12月期间接受了DCD心脏移植。移植分为4组：女性供体/女性受体（FD/FR）、女性供体/男性受体（FD/MR）、男性供体/男性受体（MD/MR）和男性供体/女性受体（MD/FR）。主要结局是急性排斥反应和术后并发症，次要结局是死亡率。采用多变量logistic回归分析与排斥相关的因素，Kaplan-Meier （KM）生存分析采用log-rank检验和事后二元比较进行比较。结果女性接受DCD移植的急性排斥反应发生率高于男性(FD/FR: 26 (20%), MD/FR: 28 (22.2%), MD/MR 110 (11.8%), FD/MR 6 (9%), p = 0.001)，卒中、透析和起搏器植入的发生率相似。在男性接受者中，体重、身高和左心室辅助装置（LVAD）与急性排斥反应有关。然而，体重和身高与女性受体的急性排斥反应无关。KM曲线显示长期死亡率无差异。结论：与男性相比，接受男性和女性供体DCD心脏的女性受者急性排斥反应的风险增加。身高和体重与男性患者的急性排斥反应有关。男性和女性接受者的长期死亡率相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.