TY - JOUR
T1 - The role of estrogen, immune function and aging in heart transplant outcomes
AU - Morgan, Ashley E.
AU - Dewey, Elizabeth
AU - Mudd, James
AU - Gelow, Jill
AU - Davis, Jonathan
AU - Song, Howard
AU - Tibayan, Frederick (Fred)
AU - Bhamidipati, Castigliano
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: 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. Methods: 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. Results: 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). Conclusions: 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.
AB - Background: 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. Methods: 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. Results: 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). Conclusions: 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.
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U2 - 10.1016/j.amjsurg.2019.07.007
DO - 10.1016/j.amjsurg.2019.07.007
M3 - Article
C2 - 31353032
AN - SCOPUS:85071335248
JO - American Journal of Surgery
JF - American Journal of Surgery
SN - 0002-9610
ER -