The incremental risk of female sex in heart transplantation

A multiinstitutional study of peripartum cardiomyopathy and pregnancy

M. R. Johnson, D. C. Naftel, R. E. Hobbs, J. A. Kobashigawa, D. E. Pitts, T. B. Levine, D. Tolman, G. Bhat, J. K. Kirklin, R. C. Bourge, D. C. Naftel, R. C. Bourge, J. K. Kirklin, D. C. McGiffin, T. Wiess, A. Crosswy, B. Austin, L. Early, P. Holmes, M. Veazey & 79 others P. Sims, K. Hubbard, J. Brush, M. R. Pritzker, K. D. Lake, M. O'Kane, S. Chapman, F. Hoffman, N. Seimers, C. Jorgensen, W. Pedersen, L. Joyce, F. Eales, R. W. Emery, T. Von Reuden, P. Bruhn, M. King, K. Arom, K. J. Heilman, D. Pacheco, C. Moore, S. Levin, P. Blair, H. O. Ventura, F. W. Smart, D. D. Stapleton, Jr Van Meter C.H., M. R. Mehra, D. Dumas-Hicks, J. B. Young, J. A. Farmer, B. Cocanougher, S. Lanthier, G. H. Mudge, J. Jarcho, P. Johnson, E. Loh, R. E. Hobbs, G. Rincon, C. Bott-Silverman, P. McCarthy, R. Stewart, L. Platt, Robert E. Michler, E. M. Burke, R. Gomez, F. Hoy, D. Geis, J. Munns, D. Best, B. Clemson, P. McRae, C. Stables, S. Faulkner, M. L. Stenstrom, S. C. Brozena, J. M. Fitzpatrick, A. K. Gash, D. Chojnowski, J. Kozak, P. Stutman, C. Twomey, D. Stinson, T. B. Levine, A. B. Levine, B. Narins, J. Boehmer, P. Frazier, P. Coe, J. O'Donnell, A. Darroca, L. Hiles, R. L. Caldwell, R. K. Darragh, T. Flaspholer, M. R. Costanzo, M. R. Johnson, W. Kao, E. Winkel

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: Controversy remains regarding the reason females seem to be at increased risk for rejection after heart transplantation. Therefore this study was performed to define the effect of a pretransplantation diagnosis of peripartum cardiomyopathy and the effect of previous pregnancy on the outcome (incidence of rejection and death) of females after heart transplantation. Methods: In this multiinstitutional study of 3244 adult (greater than 13 years of age) heart transplant recipients, (a) the outcome of 40 females who underwent transplantation for peripartum cardiomyopathy was compared with that of 200 females of childbearing age (13 to 45 years) who underwent transplantation for other indications and (b) the posttransplantation outcome of 543 females with a history of pregnancy was compared with that of 101 nulliparous adult females and 2562 adult males. Results: The posttransplantation outcome of females with a history of peripartum cardiomyopathy was similar to that of females of childbearing age who underwent transplantation for other indications. However, parous females had a significantly shorter time to first rejection (p < 0.0001) and greater cumulative rejection than nulliparous females or males. By multivariable analysis, the risk factors for cumulative rejection at 1 year were a history of pregnancy (p < 0.0001), younger recipient age (p < 0.0001), induction therapy (p < 0.0001), and the number of human leukocyte antigen-DR mismatches (p = 0.007). Conclusion: Our data suggest that it is previous pregnancy, and not sex per se, that is associated with an increased frequency of rejection in females after heart transplantation.

Original languageEnglish (US)
Pages (from-to)801-812
Number of pages12
JournalJournal of Heart and Lung Transplantation
Volume16
Issue number8
StatePublished - 1997
Externally publishedYes

Fingerprint

Peripartum Period
Heart Transplantation
Cardiomyopathies
Pregnancy
Reproductive History
Transplantation
Pregnancy Outcome
HLA Antigens

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Johnson, M. R., Naftel, D. C., Hobbs, R. E., Kobashigawa, J. A., Pitts, D. E., Levine, T. B., ... Winkel, E. (1997). The incremental risk of female sex in heart transplantation: A multiinstitutional study of peripartum cardiomyopathy and pregnancy. Journal of Heart and Lung Transplantation, 16(8), 801-812.

The incremental risk of female sex in heart transplantation : A multiinstitutional study of peripartum cardiomyopathy and pregnancy. / Johnson, M. R.; Naftel, D. C.; Hobbs, R. E.; Kobashigawa, J. A.; Pitts, D. E.; Levine, T. B.; Tolman, D.; Bhat, G.; Kirklin, J. K.; Bourge, R. C.; Naftel, D. C.; Bourge, R. C.; Kirklin, J. K.; McGiffin, D. C.; Wiess, T.; Crosswy, A.; Austin, B.; Early, L.; Holmes, P.; Veazey, M.; Sims, P.; Hubbard, K.; Brush, J.; Pritzker, M. R.; Lake, K. D.; O'Kane, M.; Chapman, S.; Hoffman, F.; Seimers, N.; Jorgensen, C.; Pedersen, W.; Joyce, L.; Eales, F.; Emery, R. W.; Von Reuden, T.; Bruhn, P.; King, M.; Arom, K.; Heilman, K. J.; Pacheco, D.; Moore, C.; Levin, S.; Blair, P.; Ventura, H. O.; Smart, F. W.; Stapleton, D. D.; Van Meter C.H., Jr; Mehra, M. R.; Dumas-Hicks, D.; Young, J. B.; Farmer, J. A.; Cocanougher, B.; Lanthier, S.; Mudge, G. H.; Jarcho, J.; Johnson, P.; Loh, E.; Hobbs, R. E.; Rincon, G.; Bott-Silverman, C.; McCarthy, P.; Stewart, R.; Platt, L.; Michler, Robert E.; Burke, E. M.; Gomez, R.; Hoy, F.; Geis, D.; Munns, J.; Best, D.; Clemson, B.; McRae, P.; Stables, C.; Faulkner, S.; Stenstrom, M. L.; Brozena, S. C.; Fitzpatrick, J. M.; Gash, A. K.; Chojnowski, D.; Kozak, J.; Stutman, P.; Twomey, C.; Stinson, D.; Levine, T. B.; Levine, A. B.; Narins, B.; Boehmer, J.; Frazier, P.; Coe, P.; O'Donnell, J.; Darroca, A.; Hiles, L.; Caldwell, R. L.; Darragh, R. K.; Flaspholer, T.; Costanzo, M. R.; Johnson, M. R.; Kao, W.; Winkel, E.

In: Journal of Heart and Lung Transplantation, Vol. 16, No. 8, 1997, p. 801-812.

Research output: Contribution to journalArticle

Johnson, MR, Naftel, DC, Hobbs, RE, Kobashigawa, JA, Pitts, DE, Levine, TB, Tolman, D, Bhat, G, Kirklin, JK, Bourge, RC, Naftel, DC, Bourge, RC, Kirklin, JK, McGiffin, DC, Wiess, T, Crosswy, A, Austin, B, Early, L, Holmes, P, Veazey, M, Sims, P, Hubbard, K, Brush, J, Pritzker, MR, Lake, KD, O'Kane, M, Chapman, S, Hoffman, F, Seimers, N, Jorgensen, C, Pedersen, W, Joyce, L, Eales, F, Emery, RW, Von Reuden, T, Bruhn, P, King, M, Arom, K, Heilman, KJ, Pacheco, D, Moore, C, Levin, S, Blair, P, Ventura, HO, Smart, FW, Stapleton, DD, Van Meter C.H., J, Mehra, MR, Dumas-Hicks, D, Young, JB, Farmer, JA, Cocanougher, B, Lanthier, S, Mudge, GH, Jarcho, J, Johnson, P, Loh, E, Hobbs, RE, Rincon, G, Bott-Silverman, C, McCarthy, P, Stewart, R, Platt, L, Michler, RE, Burke, EM, Gomez, R, Hoy, F, Geis, D, Munns, J, Best, D, Clemson, B, McRae, P, Stables, C, Faulkner, S, Stenstrom, ML, Brozena, SC, Fitzpatrick, JM, Gash, AK, Chojnowski, D, Kozak, J, Stutman, P, Twomey, C, Stinson, D, Levine, TB, Levine, AB, Narins, B, Boehmer, J, Frazier, P, Coe, P, O'Donnell, J, Darroca, A, Hiles, L, Caldwell, RL, Darragh, RK, Flaspholer, T, Costanzo, MR, Johnson, MR, Kao, W & Winkel, E 1997, 'The incremental risk of female sex in heart transplantation: A multiinstitutional study of peripartum cardiomyopathy and pregnancy', Journal of Heart and Lung Transplantation, vol. 16, no. 8, pp. 801-812.
Johnson, M. R. ; Naftel, D. C. ; Hobbs, R. E. ; Kobashigawa, J. A. ; Pitts, D. E. ; Levine, T. B. ; Tolman, D. ; Bhat, G. ; Kirklin, J. K. ; Bourge, R. C. ; Naftel, D. C. ; Bourge, R. C. ; Kirklin, J. K. ; McGiffin, D. C. ; Wiess, T. ; Crosswy, A. ; Austin, B. ; Early, L. ; Holmes, P. ; Veazey, M. ; Sims, P. ; Hubbard, K. ; Brush, J. ; Pritzker, M. R. ; Lake, K. D. ; O'Kane, M. ; Chapman, S. ; Hoffman, F. ; Seimers, N. ; Jorgensen, C. ; Pedersen, W. ; Joyce, L. ; Eales, F. ; Emery, R. W. ; Von Reuden, T. ; Bruhn, P. ; King, M. ; Arom, K. ; Heilman, K. J. ; Pacheco, D. ; Moore, C. ; Levin, S. ; Blair, P. ; Ventura, H. O. ; Smart, F. W. ; Stapleton, D. D. ; Van Meter C.H., Jr ; Mehra, M. R. ; Dumas-Hicks, D. ; Young, J. B. ; Farmer, J. A. ; Cocanougher, B. ; Lanthier, S. ; Mudge, G. H. ; Jarcho, J. ; Johnson, P. ; Loh, E. ; Hobbs, R. E. ; Rincon, G. ; Bott-Silverman, C. ; McCarthy, P. ; Stewart, R. ; Platt, L. ; Michler, Robert E. ; Burke, E. M. ; Gomez, R. ; Hoy, F. ; Geis, D. ; Munns, J. ; Best, D. ; Clemson, B. ; McRae, P. ; Stables, C. ; Faulkner, S. ; Stenstrom, M. L. ; Brozena, S. C. ; Fitzpatrick, J. M. ; Gash, A. K. ; Chojnowski, D. ; Kozak, J. ; Stutman, P. ; Twomey, C. ; Stinson, D. ; Levine, T. B. ; Levine, A. B. ; Narins, B. ; Boehmer, J. ; Frazier, P. ; Coe, P. ; O'Donnell, J. ; Darroca, A. ; Hiles, L. ; Caldwell, R. L. ; Darragh, R. K. ; Flaspholer, T. ; Costanzo, M. R. ; Johnson, M. R. ; Kao, W. ; Winkel, E. / The incremental risk of female sex in heart transplantation : A multiinstitutional study of peripartum cardiomyopathy and pregnancy. In: Journal of Heart and Lung Transplantation. 1997 ; Vol. 16, No. 8. pp. 801-812.
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title = "The incremental risk of female sex in heart transplantation: A multiinstitutional study of peripartum cardiomyopathy and pregnancy",
abstract = "Background: Controversy remains regarding the reason females seem to be at increased risk for rejection after heart transplantation. Therefore this study was performed to define the effect of a pretransplantation diagnosis of peripartum cardiomyopathy and the effect of previous pregnancy on the outcome (incidence of rejection and death) of females after heart transplantation. Methods: In this multiinstitutional study of 3244 adult (greater than 13 years of age) heart transplant recipients, (a) the outcome of 40 females who underwent transplantation for peripartum cardiomyopathy was compared with that of 200 females of childbearing age (13 to 45 years) who underwent transplantation for other indications and (b) the posttransplantation outcome of 543 females with a history of pregnancy was compared with that of 101 nulliparous adult females and 2562 adult males. Results: The posttransplantation outcome of females with a history of peripartum cardiomyopathy was similar to that of females of childbearing age who underwent transplantation for other indications. However, parous females had a significantly shorter time to first rejection (p < 0.0001) and greater cumulative rejection than nulliparous females or males. By multivariable analysis, the risk factors for cumulative rejection at 1 year were a history of pregnancy (p < 0.0001), younger recipient age (p < 0.0001), induction therapy (p < 0.0001), and the number of human leukocyte antigen-DR mismatches (p = 0.007). Conclusion: Our data suggest that it is previous pregnancy, and not sex per se, that is associated with an increased frequency of rejection in females after heart transplantation.",
author = "Johnson, {M. R.} and Naftel, {D. C.} and Hobbs, {R. E.} and Kobashigawa, {J. A.} and Pitts, {D. E.} and Levine, {T. B.} and D. Tolman and G. Bhat and Kirklin, {J. K.} and Bourge, {R. C.} and Naftel, {D. C.} and Bourge, {R. C.} and Kirklin, {J. K.} and McGiffin, {D. C.} and T. Wiess and A. Crosswy and B. Austin and L. Early and P. Holmes and M. Veazey and P. Sims and K. Hubbard and J. Brush and Pritzker, {M. R.} and Lake, {K. D.} and M. O'Kane and S. Chapman and F. Hoffman and N. Seimers and C. Jorgensen and W. Pedersen and L. Joyce and F. Eales and Emery, {R. W.} and {Von Reuden}, T. and P. Bruhn and M. King and K. Arom and Heilman, {K. J.} and D. Pacheco and C. Moore and S. Levin and P. Blair and Ventura, {H. O.} and Smart, {F. W.} and Stapleton, {D. D.} and {Van Meter C.H.}, Jr and Mehra, {M. R.} and D. Dumas-Hicks and Young, {J. B.} and Farmer, {J. A.} and B. Cocanougher and S. Lanthier and Mudge, {G. H.} and J. Jarcho and P. Johnson and E. Loh and Hobbs, {R. E.} and G. Rincon and C. Bott-Silverman and P. McCarthy and R. Stewart and L. Platt and Michler, {Robert E.} and Burke, {E. M.} and R. Gomez and F. Hoy and D. Geis and J. Munns and D. Best and B. Clemson and P. McRae and C. Stables and S. Faulkner and Stenstrom, {M. L.} and Brozena, {S. C.} and Fitzpatrick, {J. M.} and Gash, {A. K.} and D. Chojnowski and J. Kozak and P. Stutman and C. Twomey and D. Stinson and Levine, {T. B.} and Levine, {A. B.} and B. Narins and J. Boehmer and P. Frazier and P. Coe and J. O'Donnell and A. Darroca and L. Hiles and Caldwell, {R. L.} and Darragh, {R. K.} and T. Flaspholer and Costanzo, {M. R.} and Johnson, {M. R.} and W. Kao and E. Winkel",
year = "1997",
language = "English (US)",
volume = "16",
pages = "801--812",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "8",

}

TY - JOUR

T1 - The incremental risk of female sex in heart transplantation

T2 - A multiinstitutional study of peripartum cardiomyopathy and pregnancy

AU - Johnson, M. R.

AU - Naftel, D. C.

AU - Hobbs, R. E.

AU - Kobashigawa, J. A.

AU - Pitts, D. E.

AU - Levine, T. B.

AU - Tolman, D.

AU - Bhat, G.

AU - Kirklin, J. K.

AU - Bourge, R. C.

AU - Naftel, D. C.

AU - Bourge, R. C.

AU - Kirklin, J. K.

AU - McGiffin, D. C.

AU - Wiess, T.

AU - Crosswy, A.

AU - Austin, B.

AU - Early, L.

AU - Holmes, P.

AU - Veazey, M.

AU - Sims, P.

AU - Hubbard, K.

AU - Brush, J.

AU - Pritzker, M. R.

AU - Lake, K. D.

AU - O'Kane, M.

AU - Chapman, S.

AU - Hoffman, F.

AU - Seimers, N.

AU - Jorgensen, C.

AU - Pedersen, W.

AU - Joyce, L.

AU - Eales, F.

AU - Emery, R. W.

AU - Von Reuden, T.

AU - Bruhn, P.

AU - King, M.

AU - Arom, K.

AU - Heilman, K. J.

AU - Pacheco, D.

AU - Moore, C.

AU - Levin, S.

AU - Blair, P.

AU - Ventura, H. O.

AU - Smart, F. W.

AU - Stapleton, D. D.

AU - Van Meter C.H., Jr

AU - Mehra, M. R.

AU - Dumas-Hicks, D.

AU - Young, J. B.

AU - Farmer, J. A.

AU - Cocanougher, B.

AU - Lanthier, S.

AU - Mudge, G. H.

AU - Jarcho, J.

AU - Johnson, P.

AU - Loh, E.

AU - Hobbs, R. E.

AU - Rincon, G.

AU - Bott-Silverman, C.

AU - McCarthy, P.

AU - Stewart, R.

AU - Platt, L.

AU - Michler, Robert E.

AU - Burke, E. M.

AU - Gomez, R.

AU - Hoy, F.

AU - Geis, D.

AU - Munns, J.

AU - Best, D.

AU - Clemson, B.

AU - McRae, P.

AU - Stables, C.

AU - Faulkner, S.

AU - Stenstrom, M. L.

AU - Brozena, S. C.

AU - Fitzpatrick, J. M.

AU - Gash, A. K.

AU - Chojnowski, D.

AU - Kozak, J.

AU - Stutman, P.

AU - Twomey, C.

AU - Stinson, D.

AU - Levine, T. B.

AU - Levine, A. B.

AU - Narins, B.

AU - Boehmer, J.

AU - Frazier, P.

AU - Coe, P.

AU - O'Donnell, J.

AU - Darroca, A.

AU - Hiles, L.

AU - Caldwell, R. L.

AU - Darragh, R. K.

AU - Flaspholer, T.

AU - Costanzo, M. R.

AU - Johnson, M. R.

AU - Kao, W.

AU - Winkel, E.

PY - 1997

Y1 - 1997

N2 - Background: Controversy remains regarding the reason females seem to be at increased risk for rejection after heart transplantation. Therefore this study was performed to define the effect of a pretransplantation diagnosis of peripartum cardiomyopathy and the effect of previous pregnancy on the outcome (incidence of rejection and death) of females after heart transplantation. Methods: In this multiinstitutional study of 3244 adult (greater than 13 years of age) heart transplant recipients, (a) the outcome of 40 females who underwent transplantation for peripartum cardiomyopathy was compared with that of 200 females of childbearing age (13 to 45 years) who underwent transplantation for other indications and (b) the posttransplantation outcome of 543 females with a history of pregnancy was compared with that of 101 nulliparous adult females and 2562 adult males. Results: The posttransplantation outcome of females with a history of peripartum cardiomyopathy was similar to that of females of childbearing age who underwent transplantation for other indications. However, parous females had a significantly shorter time to first rejection (p < 0.0001) and greater cumulative rejection than nulliparous females or males. By multivariable analysis, the risk factors for cumulative rejection at 1 year were a history of pregnancy (p < 0.0001), younger recipient age (p < 0.0001), induction therapy (p < 0.0001), and the number of human leukocyte antigen-DR mismatches (p = 0.007). Conclusion: Our data suggest that it is previous pregnancy, and not sex per se, that is associated with an increased frequency of rejection in females after heart transplantation.

AB - Background: Controversy remains regarding the reason females seem to be at increased risk for rejection after heart transplantation. Therefore this study was performed to define the effect of a pretransplantation diagnosis of peripartum cardiomyopathy and the effect of previous pregnancy on the outcome (incidence of rejection and death) of females after heart transplantation. Methods: In this multiinstitutional study of 3244 adult (greater than 13 years of age) heart transplant recipients, (a) the outcome of 40 females who underwent transplantation for peripartum cardiomyopathy was compared with that of 200 females of childbearing age (13 to 45 years) who underwent transplantation for other indications and (b) the posttransplantation outcome of 543 females with a history of pregnancy was compared with that of 101 nulliparous adult females and 2562 adult males. Results: The posttransplantation outcome of females with a history of peripartum cardiomyopathy was similar to that of females of childbearing age who underwent transplantation for other indications. However, parous females had a significantly shorter time to first rejection (p < 0.0001) and greater cumulative rejection than nulliparous females or males. By multivariable analysis, the risk factors for cumulative rejection at 1 year were a history of pregnancy (p < 0.0001), younger recipient age (p < 0.0001), induction therapy (p < 0.0001), and the number of human leukocyte antigen-DR mismatches (p = 0.007). Conclusion: Our data suggest that it is previous pregnancy, and not sex per se, that is associated with an increased frequency of rejection in females after heart transplantation.

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M3 - Article

VL - 16

SP - 801

EP - 812

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 8

ER -