Gender Differences in Waitlist and Heart Transplant Outcomes in Hypertrophic Cardiomyopathy Patients After the 2018 UNOS Donor Heart Allocation Policy.

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

Journal of Cardiac Failure

Abstract

Introduction and Hypothesis: Hypertrophic cardiomyopathy (HCM) does not have a predilection for gender; however, underrecognition and delayed diagnosis disproportionately affects women, leading to higher incidence of advanced heart failure. End stage HCM (non-obstructive) is an increasing cause of morbidity and mortality, with HCM patients accounting for 3.5% of heart transplant (HT) recipients. Recent changes in the UNOS donor heart allocation policy acknowledged the unique pathophysiology of HCM-related advanced heart failure and led to an increase in the number of transplants. This study aims to investigate sex-based differences in HCM patients undergoing HT following the adoption of the 2018 UNOS donor heart allocation policy.

Methods: HCM patients in the UNOS database who were listed for HT between 10-18-2018 and 06-30-2023 were included in the study. Heart re-transplant, multi-organ listings and candidates listed for organs other than heart were excluded. Patients were classified according to female (F) or male (M) sex. Clinical characteristics at the time of listing, HT and post-transplant survival were compared between male and female recipients.

Results: A total of 560 patients (233 female, 327 male) were included in the study. One year post transplant adjusted survival was similar (97.7% F, 98.2% M; p=0.562). However, the study found statistically significant differences in age at HT (48.9±13.18 y F vs 52.28±12.09 y M; p=0.009), with no difference in HT rate 1 year after listing (74.6% F, 76.1% M; p=0.5). Distribution of Listing Status was different by sex at time of listing (p=0.001) and transplant (p< 0.001), with a greater proportion of males assigned Status 1-2 whereas the majority of females were Status 4. An underlying reason may be a higher proportion of males on IABP (24.1% M vs 12.43% F; p=0.005) and inotropes (38.55% M vs 21.3% F; p< 0.001). Small differences in hemodynamic parameters did not appear clinically significant to account for the increased utilization of mechanical/inotropic support. However, the number of days waiting for HT was (97.01±161.6 F vs 96.89±156.2 M; p=0.775).

Conclusions: Survival one year post HT in patients with HCM was similar in females and males, indicating that the 2018 donor heart allocation policy is not disproportionately affecting mortality outcomes by sex. This analysis raises the question of how both sexes have similar wait time despite males being assigned higher status levels at listing and transplant. One possible explanation for this could be differences in donor heart size requirements between males and females. Further investigation is necessary to explore and adjust for contributing factors.

Volume

31

Issue

1

First Page

255

Comments

Heart Failure Society of America (HFSA) Annual Scientific Meeting, September 27-30, 2024, Atlanta, GA

Last Page

256

DOI

10.1016/j.cardfail.2024.10.192

ISSN

1532-8414

Link to Full Text

Share

COinS