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Increased delay to lung transplantation for women candidates: gender-based disparity matters in the lung transplant trajectory
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Edité par CCSD ; European Respiratory Society -
International audience. Background Lung transplantation (LT) is a highly dynamic segment of solid organ transplantation in which gender plays a central role . Our objective was to investigate the causes of outcome differences between women and men all along the LT pathway. Methods We used data from the COhort in Lung Transplantation (COLT) study (12 participating LT centers). Analyses were performed in three phases: baseline clinical characteristics, peri-transplantation period, and post-transplantation follow-up. Results Overall, 1710 participants (802 women and 908 men) were included in this study. Women were less likely than men to undergo transplantation (91.6% versus 95.6%, p=0.001) and waited longer before transplantation (115 versus 73 days, p<0.001). Female gender and pre-transplant class I anti-HLA antibodies were identified as independent factors associated with longer waiting time duration. Female LT recipients commonly received lungs from height- and sex-matched donors, despite higher female waiting-list mortality and a higher proportion of male donors. Importantly, women with oversized lung transplantation (defined by predicted TLC ratio and weight mismatch) did not have worse survival. The overall post-transplant survival of female recipients was significantly higher than that of male recipients (65.6% versus 57.3%, p<0.001), although the prevalence of specific major LT outcomes did not differ according to gender. Conclusion Women waited longer and were less likely to undergo transplant. Women transplanted with an oversized lung did not have worse survival after transplantation, suggesting that size matching criteria based on pTLC ratio and weight mismatch may be less stringent in this context.
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