The role of estrogen, immune function and aging in heart transplant outcomes

• Published in: The American journal of surgery 2019-10, Vol.218 (4), p.737-743
• Main Authors: Morgan, Ashley E., Dewey, Elizabeth, Mudd, James O., Gelow, Jill M., Davis, Jonathan, Song, Howard K., Tibayan, Frederick A., Bhamidipati, Castigliano M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Age Factors; Aging; Antigens; Autoimmune diseases; Cardiac Output; Diabetes; Estrogens; Female; Gender; Gender aspects; Heart failure; Heart Failure - immunology; Heart Failure - mortality; Heart Failure - surgery; Heart transplantation; Heart Transplantation - mortality; Hemodialysis; Humans; Hypotheses; Hypothesis testing; Immune response; Kaplan-Meier Estimate; Male; Men; Menopause; Middle Aged; Patients; Post-menopause; Retrospective Studies; Sex differences; Sex Factors; Survival; Survival Rate; Transplants & implants; Ventilators; Women; Womens health; Young Adult
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.07.007

Aging and loss of estrogen suppress immune function, potentially improving survival after orthotopic heart transplant (OHT). The effect of female aging on OHT outcomes is unknown. Between 1995 and 2015, 41,299 adult OHT recipients (24.3% women) were studied using a retrospective multi-institutional cohort. Patients were stratified by age and gender into premenopausal (18–39 years), perimenopausal (40–49 years), and postmenopausal (≥50 years) groups. Kaplan-Meier survival analyses and risk-adjusted models examined gender differences across groups at one, five, and ten years. Kaplan-Meier survival was equivalent for postmenopausal women and men, and lower for premenopausal women than men at all time points (p ≤ 0.05). Postmenopausal women had higher risk-adjusted five-year survival than premenopausal women (AOR 1.61, 95% CI 1.15–2.25, p = 0.006). Premenopausal women have lower unadjusted survival than men after OHT. Post-menopausal women have significantly better five-year survival than pre-menopausal women. Menopause may contribute to improved survival after OHT. •We compared survival between age-matched men and women after heart transplant.•Post-menopausal women and age-matched men had equivalent unadjusted survival.•Risk-adjusted survival was equivalent between men and women of all age groups.•Postmenopausal women had better risk-adjusted survival than premenopausal women.•Menopause, with associated loss of estrogen, may improve survival after transplant.