The Effect of Gender Combinations on Outcome in Human Lung Transplantation: The International Society of Heart and Lung Transplantation Registry Experience
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BACKGROUND: In the current practice of lung transplantation, donor and recipient genders are neither directly considered nor matched. METHODS: We analyzed the potential effect of gender combinations on survival in 9,651 lung transplant recipients in the International Society of Heart and Lung Transplantation Registry (ISHLT) Registry. We compared the risk of overall and 90-day mortality by using statistical models that accounted for confounding variables. RESULTS: A Kaplan-Meier survival analysis revealed a significant difference of survival among gender combinations (log rank, p = 0.0009). The unadjusted odds ratio (OR) of 90-day mortality was significantly higher in female (F) donors to male (M) recipients (OR, 1.58; 95% confidence interval (CI), 1.22-2.04; p < 0.001) and lower in F to F (OR, 0.742; 95% CI, 0.61-0.90; p = 0.004) compared with the reference category of M to M. After adjusting for size mismatch and diagnosis in the multivariate logistic regression model, the OR of F to M was still statistically significant (F to M OR, 1.52l; 95% CI, 1.04-2.20; p = 0.028; F to F OR, 0.67; 95% CI, 0.53-0.91; p = 0.008) for 90-day mortality. A Cox proportional hazards analysis for overall survival also showed a significantly higher hazard ratio of 1.12 in F to M (95% CI, 1.01-1.23) and a lower hazard ratio of 0.92 in F to F (95% CI, 0.87-0.98). CONCLUSION: ISHLT Lung Transplant Registry data demonstrated a significant risk for F to M. Interestingly, F to F appears to be potentially beneficial in lung transplantation. Gender combinations do appear to significantly impact outcome after lung transplantation.
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