Authors
Roxana Moayedifar, Andreas Zuckerman, Yasbanoo Moayedi, Rong Huang, Nititsh K Dhingra, Lauren K Truby, Jiho Han, Erik Henricksen, Eduard Ródenas-Alesina, Joan Guzman-Bofarull, David Couto-Mallon, Helen Luikart, Marisa Signorile, Maryjane Farr, Gene Kim, Maria G Crespo-Leiro, Shelley Hall, Adam DeVore, Joseph B Lerman, Mario Sabatino, Luciano Potena, Mercedes Rivas-Lasarte, Javier Segovia-Cubero, Marta Farrero, Maxime Tremblay-Gravel, Pierre Emmanuel Noly, Robert Miller, Sharon Chih, Koji Takeda, Heather J Ross, Farid Foroutan, Kiran Khush
Published in
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. Oct 26, 2026. Epub Oct 26, 2026.
Abstract
The association between sex and primary graft dysfunction after heart transplantation (HT) remains unclear. We evaluated whether recipient sex and donor-recipient sex matching are associated with severe primary graft dysfunction (PGD) in a contemporary, multicenter cohort.
We analyzed data from the International PGD Consortium comprised of adult HTs from 2010 to 2024 across 14 centers. Associations between sex-related variables and severe PGD were assessed using multivariable logistic regression, and adjusted for ischemic time, pre-transplant durable left ventricular assist device (LVAD), dialysis, congenital heart disease, and predicted heart mass (PHM) ratio.
Among 3,994 recipients, 1,030 (25.8%) were female. Female recipients were younger (54 vs. 57 years) with fewer comorbidities, and less frequently bridged on a durable LVAD (19.8% vs. 29.1%). Although female recipients had a lower incidence of PGD than male recipients (7.1% vs. 9.4%), recipient sex was not independently associated with PGD after multivariable adjustment. Female donor to male recipient sex mismatching had the highest PGD incidence of 11.5% and was associated with a 43% increase in the odds of severe PGD (p=0.030). While sex-mismatch was associated with an increased incidence of PGD, size mismatch by PHM ratio was not an independent predictor.
In this large international registry, donor-recipient sex mismatch, specifically among male recipients of female donor hearts, was independently associated with severe PGD, even when appropriately size matched. These findings inform risk stratification for development of severe PGD after HT.
PMID:
42933551
Bibliographic data and abstract were imported from PubMed on 27 Oct 2026.
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