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(Circulation. 2001;104:I-177.)
© 2001 American Heart Association, Inc.

Thoracic Transplantation and Ventricular Assist Devices

Increased Prevalence of Autoimmune Phenomena and Greater Risk for Alloreactivity in Female Heart Transplant Recipients

Katherine Lietz, MD, PhD; Ranjit John, MD; Alfred Kocher, MD; Michael Schuster, BS; Donna M. Mancini, MD; Niloo M. Edwards, MD; Silviu Itescu, MD

From the Divisions of Cardiothoracic Surgery (K.L., R.J., A.K., M.S., N.M.E., S.I.) and Cardiology (D.M.M.), Columbia Presbyterian Medical Center, Columbia University, New York, NY.

Correspondence to Silviu Itescu, MD, Division of Cardiothoracic Surgery, Columbia Presbyterian Medical Center, 630 W 168th St, P&S 14-402, New York, NY 10032. E-mail si5{at}columbia.edu

Background— The influence of sex on alloreactivity and graft outcome after heart transplantation was evaluated.

Methods and Results— A retrospective review of 520 consecutive recipients of a primary cardiac allograft between 1992 and 2000 at a single center was performed. The influence of sex on alloreactivity, acute rejection, transplant-related coronary artery disease, and survival was determined. Statistical methods included logistic regression analysis and Kaplan-Meier actuarial survival analysis. Female recipients had an increased prevalence before transplant of idiopathic cardiomyopathy, antinuclear antibodies, and HLA-B8, DR3 haplotypes. After transplant, female sex predicted shorter duration to a first rejection, higher cumulative rejection frequency, and earlier posttransplant production of anti-HLA antibodies. Female recipients had higher early mortality rates (<6 months) that were due to infection. Fatal infections correlated with 2-fold higher cyclosporine levels in female recipients. However, the incidence of transplant-related coronary artery disease developing beyond 1 year after transplant was lower in female than in male recipients.

Conclusions— Females undergoing cardiac transplantation are more likely to manifest features of an underlying autoimmune state. This may predispose to a higher posttransplant risk of allograft rejection and requirement for increased immunosuppression. Earlier diagnosis and management of alloreactivity in female recipients before development of acute rejection and the use of more focused and less globally immunosuppressive agents during established rejections may have a significant effect on the clinical outcome of female cardiac allograft recipients.

Key Words: transplantation • immune system • immunology