Women vs. men undergo fewer lung transplants, face longer wait times
Key takeaways:
- A significantly higher proportion of men vs. women in France underwent lung transplantation.
- Multivariable analysis revealed that one of the two factors independently linked to a longer wait was female sex.
A smaller proportion of women vs. men underwent lung transplantation, plus women spent a longer time on the wait list before receiving the transplant, according to results published in ERJ Open Research.
“Clinicians, patients and policymakers must acknowledge this gender difference as it’s essential for appropriate action to be taken,” Adrien Tissot, MD, from Nantes University Hospital in France, said in a press release. “Early listing for women or revising allocation policy of donor lung to recipient could be considered.”
In this study, Tissot and colleagues evaluated 802 women (median age at wait list registration, 47 years) and 908 men (median age at wait list registration, 54 years) from the French COhort in Lung Transplantation study to determine how sex impacts the likelihood for transplantation, time to transplantation and survival following the procedure.
A significantly higher proportion of men vs. women underwent lung transplantation (95.6% vs. 91.6%; P = .001), according to the study.
In terms of wait time, researchers learned that women waited a median of 115 days before undergoing the procedure, whereas men only waited a median of 73 days (P < .001).
Notably, multivariable analysis revealed that one of the two factors independently linked to a longer wait time was female sex. The other factor reported in the study was number of class I anti-human leukocyte antigen antibodies prior to transplantation.
Among those who received a lung transplant, donors matched to the recipient by height and sex was a frequent occurrence in women. This finding was interesting as researchers simultaneously noted heightened waiting list mortality among women and more men vs. women donors.
The study further highlighted that instances where the donor-to-recipient predicted total lung capacity (TLC) ratio was greater than 1.41 were reported in a significantly higher proportion of women vs. men recipients (10.1% vs. 0.1%; P < .001).
On a similar note, researchers observed that 41.2% of women received their lungs from donors that weighed greater than 15 kg than them, whereas this occurred less often in men (30.6%; P < .001).
Significantly more women vs. men who received a lung transplant survived when checked at the median follow-up time of 5.7 years (65.6% vs. 57.3%; P < .001). According to the study, survival was not poorer in women recipients of an oversized lung transplantation, meaning “predicted TLC ratio and weight mismatch.”
When assessing the occurrence of major lung transplantation outcomes, such as chronic lung allograft dysfunction, acute cellular rejection, antibody-mediated rejection, bacterial infection, fungal infection and viral infection, researchers found comparable proportions of women and men experiencing each outcome.
“We believe our findings, such as the potential role of size matching and its consequence on access to lung transplantation, and length of time on the waiting list, may also apply in other countries where lung transplantation is performed,” Tissot said in the release.
Reference:
- Women are less likely to get a lung transplant than men and they spend six weeks longer on the waiting list. https://www.eurekalert.org/news-releases/1069511. Published Jan. 8, 2025. Accessed Jan. 8, 2025.
Perspective
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This retrospective study is based on data from the French Cohort in Lung Transplantation database. The fact that women wait longer for a transplant despite being generally younger and having fewer comorbidities due to the higher rates of anti-HLA antibodies and body size mismatches offers new insights into the challenges women face in the lung transplant process. In addition, the current study found that female lung transplant recipients have better survival outcomes than male recipients, which is a significant finding. This aligns with other studies suggesting better survival rates in female transplant recipients in some organ types, although the mechanisms remain unclear.
The gender differences observed align with anecdotal experiences, particularly in how organ matching and waiting list management occur historically. In the U.S., with the implementation of the new Lung CAS system, patients with high levels of sensitization and short stature who previously have been at a disadvantage can now receive extra points leading to higher scores and reduced waitlist time. Further investigations are needed in the post-CAS era in the U.S. and with diverse populations, particularly in regions outside of Europe, to assess whether these gender differences in waiting times, donor-recipient mismatching and post-transplant outcomes are consistent globally. Based on investigations, further modification of scoring systems in other countries may be required to reduce waitlist time for disadvantaged populations.
In addition, the reasons for better post-transplant survival in women should be further explored. This could include examining factors such as immune system differences, post-transplant compliance or gender-specific lifestyle factors that could influence outcomes. Continuing to follow long-term post-transplant survival and analyzing how gender influences factors such as chronic lung allograft dysfunction, graft failure and cancer risks could also offer further insights into personalized post-transplant care. By building on these findings, future research can aim to mitigate the disparities identified, thereby improving care and outcomes for all lung transplant recipients.
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