Women and men are (not quite) equals on heart transplants

Even though research finds women and men tolerate heart transplants equally well, other gender disparities remain to be investigated.

Past research on post-transplant survival rates and gender has shown conflicting results. This more recent study examined data from 34,198 international heart transplant recipients from 2004 to 2014 and, after adjusting for recipient and donor factors, found "no significant survival difference" between men and women.

The study also found women who get heart transplants appear to have lower risk features than male recipients, with fewer instances of diabetes, high blood pressure, smoking, peripheral vascular disease and past cardiovascular surgery. Yet women appear to receive higher-risk hearts than men.

"We need to better understand the matching of risk with recipient," said lead author Dr. Yasbanoo Moayedi. "We hypothesize that women tend to deteriorate more acutely, and they're sicker, so they take any heart that's available."

She said the findings suggest women with advanced heart failure need to be referred a bit earlier for transplant. "One takeaway of the study is that maybe we're missing the optimal window (for women). Many factors may determine access to transplant, but gender should not be one of them."

The study was limited by its observational nature and its lack of data on waitlist mortalities, donor race and information about how sick patients were when they received a transplant.

An estimated 6 million U.S. adults have heart failure. In 2018, there were 3,658 heart transplants, according to the United Network for Organ Sharing.

Moayedi would like to see future studies explore why more women don't undergo heart transplants and how a doctor's gender might play into that decision.

"Is it that women don't see themselves worthy enough for a heart transplant? As a patient, should I be more of an advocate for my symptoms? These things need to be looked at more systematically to learn how to best help the patient," she said.