TY - JOUR
T1 - Increased early mortality in women undergoing cardiac transplantation
AU - Wechsler, Mindy E.
AU - Giardina, Elsa Grace V.
AU - Sciacca, Robert R.
AU - Rose, Eric A.
AU - Barr, Mark L.
PY - 1995/2/15
Y1 - 1995/2/15
N2 - Background: To evaluate factors that explain sex differences affecting mortality after cardiac transplantation, a retrospective analysis of adult patients undergoing orthotopic cardiac transplantation was undertaken at the Columbia-Presbyterian Medical Center. Methods and Results: The study population consisted of 379 patients (75 women, 304 men) ≥18 years of age who survived for ≥48 hours after undergoing orthotopic cardiac transplantation between March 1985 and March 1992. The following were analyzed: incidence of death and treated rejection episodes, donor and recipient cytomegalovirus (CMV) matches, use of OKT3 induction therapy, and donor and recipient HLA mismatches. Women 49±12 years old and men 47±12 years old were characterized by differences in race and diagnosis. Women were more likely to be nonwhite (P<.01) and have idiopathic cardiomyopathy than were men (P<.01). A trend toward an increase in first-year rejection frequency was seen in women compared with men (P=.08). Overall actuarial survival was significantly reduced in women after transplantation (P<.05). At 36 months, female actuarial survival was 64±7% versus 76±3% for men (P<.05). The majority of patients in this study did not receive CMV prophylaxis. Univariate analysis revealed that only CMV(+) donor status and the use of OKT3 induction therapy affected survival in women. Multivariate analysis revealed a marked reduction in survival in female recipients of CMV(+) donors given OKT3 induction therapy. At 36 months, only 25% of women were still alive compared with 86% of women with neither risk factor (P<.001). Even without OKT3 induction there was markedly reduced survival in women with mismatched CMV status, ie, CMV(-) recipients of CMV(+) donors; 17% survival after 36 months versus 86% in women who were CMV(+) recipients (P<.05). Although at this institution during the study time period, CMV prophylaxis was not routinely employed and OKT3 induction was selectively used in higher-risk patients, conclusions regarding differences in outcome that are sex dependent are valid. Conclusions: (1) Women are at risk for reduced actuarial survival up to 3 years after cardiac transplantation. (2) Univariate analysis shows that women are selectively at risk for death when receiving hearts from CMV(+) donors and after receiving OKT3 induction therapy. (3) Multivariate analysis reveals that women are at even greater risk for death when receiving hearts from CMV(+) donors in conjunction with OKT3 induction therapy. (4) In the absence of OKT3 use, the greatest risk of death occurs in CMV(-) women transplanted with CMV(+) donor hearts. (5) When female to male survival curves are compared, factors that influenced survival in women did not appear to be problematic in men.
AB - Background: To evaluate factors that explain sex differences affecting mortality after cardiac transplantation, a retrospective analysis of adult patients undergoing orthotopic cardiac transplantation was undertaken at the Columbia-Presbyterian Medical Center. Methods and Results: The study population consisted of 379 patients (75 women, 304 men) ≥18 years of age who survived for ≥48 hours after undergoing orthotopic cardiac transplantation between March 1985 and March 1992. The following were analyzed: incidence of death and treated rejection episodes, donor and recipient cytomegalovirus (CMV) matches, use of OKT3 induction therapy, and donor and recipient HLA mismatches. Women 49±12 years old and men 47±12 years old were characterized by differences in race and diagnosis. Women were more likely to be nonwhite (P<.01) and have idiopathic cardiomyopathy than were men (P<.01). A trend toward an increase in first-year rejection frequency was seen in women compared with men (P=.08). Overall actuarial survival was significantly reduced in women after transplantation (P<.05). At 36 months, female actuarial survival was 64±7% versus 76±3% for men (P<.05). The majority of patients in this study did not receive CMV prophylaxis. Univariate analysis revealed that only CMV(+) donor status and the use of OKT3 induction therapy affected survival in women. Multivariate analysis revealed a marked reduction in survival in female recipients of CMV(+) donors given OKT3 induction therapy. At 36 months, only 25% of women were still alive compared with 86% of women with neither risk factor (P<.001). Even without OKT3 induction there was markedly reduced survival in women with mismatched CMV status, ie, CMV(-) recipients of CMV(+) donors; 17% survival after 36 months versus 86% in women who were CMV(+) recipients (P<.05). Although at this institution during the study time period, CMV prophylaxis was not routinely employed and OKT3 induction was selectively used in higher-risk patients, conclusions regarding differences in outcome that are sex dependent are valid. Conclusions: (1) Women are at risk for reduced actuarial survival up to 3 years after cardiac transplantation. (2) Univariate analysis shows that women are selectively at risk for death when receiving hearts from CMV(+) donors and after receiving OKT3 induction therapy. (3) Multivariate analysis reveals that women are at even greater risk for death when receiving hearts from CMV(+) donors in conjunction with OKT3 induction therapy. (4) In the absence of OKT3 use, the greatest risk of death occurs in CMV(-) women transplanted with CMV(+) donor hearts. (5) When female to male survival curves are compared, factors that influenced survival in women did not appear to be problematic in men.
KW - clinical trials
KW - rejection
KW - risk factors
KW - transplantation
UR - http://www.scopus.com/inward/record.url?scp=0028930922&partnerID=8YFLogxK
U2 - 10.1161/01.CIR.91.4.1029
DO - 10.1161/01.CIR.91.4.1029
M3 - Article
C2 - 7850938
AN - SCOPUS:0028930922
SN - 0009-7322
VL - 91
SP - 1029
EP - 1035
JO - Circulation
JF - Circulation
IS - 4
ER -