Sex Differences in Risk for Severe Primary Graft Dysfunction After Heart Transplantation: A GUARDIAN-Heart Analysis

Document Type

Conference Proceeding

Publication Date

8-2025

Publication Title

American Journal of Transplantation

Abstract

Purpose: Primary graft dysfunction (PGD) is a feared complication after heart transplantation (HT) in the immediate post-operative setting. Data are limited regarding sex-specific outcomes of PGD. We sought to examine sex differences in PGD using the GUARDIAN-Heart Registry. Methods: The GUARDIAN-Heart registry is the largest multicenter registry assessing the impact of organ preservation methods on HT outcomes. For the current analysis, adult (>18 years) patients in the registry who underwent HT from October 2015 through July 2024 were included. Baseline characteristics and clinical outcomes were compared between men and women independent of preservation method. Logistic regression was performed to examine the effect of sex on PGD. Results: A total of 1394 (389 women, 28%) HT recipients were included. On average, women were younger than men at HT (52 vs 55 years, p< 0.001) more likely to identify as Black (34% vs 20%, p< 0.001), and had higher peak calculated panel reactive antibody levels (28% vs 15%, p< 0.001). Overall, rates of pre-transplant extracorporeal membrane oxygenation and intra-aortic balloon pumps did not significantly differ by sex. Women were significantly less like to have a male donor (32% vs 82%, p< 0.001) and also less likely to receive a donation after circulatory death (DCD) donor (2% vs 4%, p = 0.047). Ischemic times were similar by sex. Post-transplant, rates of severe LV-PGD were similar by sex (8.7% in women vs 8.6% in men, p = 0.92). Likewise, there were no differences in observed rates of severe PGD-RV (2.3% in women vs 2.9% in men, p = 0.71), rates of severe RV dysfunction at 24 hours (7.8% in women vs 7.7% in men, p>0.99), or rates of temporary mechanical circulatory support (10% in women vs 10% in men, p = 0.84). Inotrope score at 24 hours, LVEF at 24 hours and ICU length of stay similarly did not differ by sex. Recipient sex was not a significant predictor of PGD (OR 1.02, 95% CI 0.68-1.55, p = 0.91). Conclusions: Despite differences in donor and recipient characteristics, risk of PGD was similar in men and women in the GUARDIAN-Heart registry.

Volume

25

Issue

8 Suppl 1

First Page

S834

Comments

American Society of Transplantation World Transplant Congress, August 2-6, 2025, San Francisco, CA

Last Page

S834

ISSN

1600-6135

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