Influencia del sexo en la mortalidad por trasplante cardiaco: subanálisis del Registro Español de Trasplante Cardiaco

The incidence of many heart diseases differs between men and women. In addition, the disease course, the number and type of complications and the prognosis can also be very different. The objective of this study was to determine whether sex differences can be observed in heart transplantations performed in Spain. Outcomes in 762 women who underwent heart transplantations in the country between May 1984 and December 2005 were compared with those in 3646 men. The analysis looked at 100 variables, including characteristics of the recipient, the donor, surgery, immunosuppression and the complications occurring during follow-up. The two sexes were compared using univariate and survival analysis. In addition, multivariate analysis was performed for each sex individually. The ratio of men to women who underwent transplantation was 5:1. Typically, women were younger than men (45±18 years vs. 51±14 years; P<.05), had a higher incidence of idiopathic dilated cardiomyopathy (39.8% vs. 31.3%; P<.05) and had fewer cardiovascular risk factors (hypertension 16.2% vs. 23.1%; P<.05, and dyslipidemia 25% vs. 36%; P<.05). Women had more emergency transplants (26.8% vs. 23.4%; P<.05) and developed acute graft failure more frequently (17.4% vs. 13.5%; P<.05). During follow-up, women had a higher incidence of bone complications (15.5% vs. 10.9%; P<.05) and lower incidences of dyslipidemia (38% vs. 45%; P<.05), hypertension (36% vs. 49%; P<.05), gastrointestinal complications (12% vs. 16%; P<.05) and malignancy (9% vs. 12.5%; P<.05). The probability of survival was lower in the short term (P<.05), but similar to that in men in the medium and long term (P=.6). Multivariate analysis identified 14 variables associated with mortality in men, compared with only five in women. In conclusion, important differences were found between men and women who underwent heart transplantation in Spain, but the probability of survival was similar in the two sexes, except in the early stages.