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Mortality higher for women while awaiting urgent heart transplant
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Women with United Network for Organ Sharing status 1 awaiting heart transplantation had higher mortality than men at the same status, according to a study.
However, women with United Network for Organ Sharing (UNOS) status 2 had lower mortality while awaiting transplant vs. their male counterparts.
“The importance of this study is when most of us actually list a patient for transplant assume that their ability to survive to time of transplant is really based on how urgent it is that they get it, and we never really thought of it as women or men had different rates of transplant and different risk of dying,” Eileen M. Hsich, MD, staff cardiologist and associate medical director for heart transplant at Cleveland Clinic, told Cardiology Today. “It’s important that we realize that women do die at a faster rate than men on the waiting list when they need urgent transplant.”
Hsich and colleagues used data from the Scientific Registry of Transplant Recipients from 2004 to 2015. Of the 33,069 participants (25% women), 7,681 were UNOS status 1A (26% women), 13,027 were UNOS status 1B (25% women) and 12,361 were UNOS status 2 (26% women). During follow-up (median, 4.3 months) 1,351 women and 4,052 men died.
Mortality by sex
After adjustment for more than 20 risk factors, women had higher mortality at UNOS status 1A (adjusted HR = 1.14; 95% CI, 1.01-1.29) and 1B (aHR = 1.17; 95% CI, 1.05-1.3) vs. men, but they had lower mortality at status 2 (aHR = 0.85; 95% CI, 0.76-0.95) compared with men.
In 2008 and 2012, the FDA approved small continuous-flow devices (HeartMate II, Thoratec Corp.; HeartWare ventricular assist device, HeartWare International), which were small enough to fit into women and could help bridge patients to transplantation.
The researchers stratified sex-based mortality differences by time and found that UNOS status 1A and 1B candidates had improved survival after 2008. Among status 1A, women had higher mortality from 2004 to 2011, but there were no sex differences found in mortality from 2012 to 2015. In status 1B participants, women had worse survival from 2004 to 2008, there were no sex differences in mortality from 2009 to 2011, and status 1B women had higher mortality from 2012 to 2015.
“When we look at that over time, we do find that things have gotten better, that the survival is more equal between genders for the highest status, but the second highest status, which is 1B, that has actually gotten worse over time despite the fact that we have these devices, and we don’t really know why,” Hsich said.
More research needed
Hsich said she and her colleagues will be looking at the more than 20 sex interactions to determine which other factors could lead to higher risk for mortality.
“We have over 20 interactions that we now need to explore, including kidney function, hemodynamics and albumin. We’re creating new statistical methods, so that I can more quickly with a machine determine which woman is at highest risk, so that we can then put that women in a special position, so that she gets the organs appropriately when [needed],” Hsich said. – by Cassie Homer
For more information:
Eileen M. Hsich, MD, can be reached at Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, J3-4, 9500 Euclid Ave., Cleveland, OH 44195; email: hsiche@ccf.org.
Disclosure: The researchers report no relevant financial disclosures.
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