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Survival rates differ for men, women on heart transplant waitlist
Researchers for a new study identified sex differences in survival among men and women on the waitlist for orthotopic heart transplantation.
Current transplant criteria for the United Network for Organ Sharing (UNOS) do not account for these differences, researchers wrote.
The study included 28,852 adults enrolled in the Scientific Registry of Transplant Recipients. All had been placed on the waiting list for orthotopic heart transplantation from 2000 to 2010. The cohort was 24% female.
Patients were stratified based on severity of illness at the time of wait-listing: UNOS status 1A for high-risk patients (n=6,613; 25% women), UNOS status 1B for intermediate-risk patients (n=9,168; 25% women) or UNOS status 2 for lower-risk, ambulatory patients (n=13,521; 24% women).
The primary endpoint was all-cause mortality prior to orthotopic heart transplantation. All patients were followed for a median of 3.7 years. During this time, 4,286 men and 1,290 women died.
On multivariable analysis adjusting for more than 30 confounders, the researchers observed a significant association between risk for death and female sex among high-risk patients classified as UNOS status 1A (adjusted HR=1.2; 95% CI, 1.05-1.37). However, risk for death was significantly reduced among lower-risk women classified as UNOS status 2 (adjusted HR=0.75; 95% CI, 0.67-0.84). Analysis revealed no difference in mortality risk between sexes among patients classified as UNOS status 1B.
The cause of the sex differences among patients awaiting orthotopic heart transplant remains unknown, the researchers concluded. However, they said these new data “should raise concern as the current UNOS transplant criteria [do] not account for this disparity.”
Jon A. Kobashigawa
In a related editorial, Cardiology Today Editorial Board member Jon A. Kobashigawa, MD, director of advanced heart disease and director of the heart transplant program at Cedars-Sinai Heart Institute, said there is “contention as to whether gender plays a role in HF morbidity and mortality.”
Kobashigawa said women typically receive less-aggressive HF treatment, and more aggressive therapy may be necessary for women classified as UNOS status 1A to achieve parity with men. He also said higher-risk women may have other characteristics, such as increased risk for pretransplant restrictive cardiomyopathy or severe biventricular diastolic HF, which may influence their response to therapy and time on the waitlist.
“Currently, changes in the UNOS donor heart allocation policy are being formulated,” Kobashigawa wrote. “… Paramount with lowering status 1A waitlist mortality in women is the need to prevent the apparent sicker course of these patients at the time of heart transplant listing, and to address prioritization of disadvantaged subgroups (which include many women) in future donor heart allocation policy.”
Disclosure: The researchers and Kobashigawa report no relevant financial disclosures.