Purpose
Studies in adults suggest a difference in survival based on sex matchup between donor and recipient. However, no such data exist for children whose recipient and donor risk factors can be quite different from adults. We sought to examine the effect of sex matchup on outcome in children using the Scientific Registry of Transplant Recipients.Methods and Materials
We examined 6077 pediatric heart transplant donor-recipient (age ¡Ü 18 yrs) data entries from the Registry between 1987-2011. Recipients were stratified into 4 groups: donor male, recipient male (MM, n=1987); donor female, recipient male (FM, n=1447); donor female, recipient female (FF, n=1132); donor male, recipient female (MF, n=1511). The primary outcome endpoint was a composite of all-cause mortality or retransplantation.
Results
MM patients had the best outcome overall (93 % at 30 days, 85.7 % at 1 year, 72.1 % at 5 years), and the MF group had the worst (90.5, 81.9 % , 66.8 % ). The MM group had a survival advantage compared to FM (91.0 % , 82.5 % , 69.6 % ), which became statistically significant after 5 years by log-rank test (p = 0.02), and approached significance (p=0.12) when adjusted for recipient age and primary diagnosis (cardiomyopathy, congenital heart disease or other) by Cox proportional hazard regression. The FF (91.3 % , 82.2 % , 70.1 % ) to MF comparison was not statistically significant. []
Conclusions
Male pediatric recipients have improved long term survival when they receive a sex-matched heart, consistent with the survival pattern seen in adult recipients. No survival advantage was seen for female recipients receiving a sex-matched heart.