CARC17: Outcomes in Heart Transplant Recipients with Sex Mismatched Organs: A Subgroup Analysis of the GUARDIAN-Heart Registry

Background: Donor and recipient sex mismatch in heart transplantation is considered a risk factor for poor outcomes. The mechanisms for this are poorly understood. We sought to assess whether a male to female or female to male donor mismatch influences outcomes following transplants using donor hearts preserved with the SherpaPak Cardiac Transport System (CTS). The CTS provides controlled hypothermic heart preservation during transportation which may abate cold injury to the donor heart. Methods: The GUARDIAN-Heart registry is an international, multicenter registry assessing outcomes following heart transplantation using donor organs preserved with CTS compared to standard ice transportation (ICE). A subgroup analysis of sex-mismatched donors and recipients resulted in cohorts of 121 ICE transplants compared to 141 CTS transplants. Summary statistics were used for comparing the groups. Further analysis with ongoing enrollment will be available for presentation. Results: The baselines of the two groups were similar, including the proportion of female to male mismatches (57% (ICE) vs 56%, (CTS), p = 0.87) and the percent undersized by >15% (17.4% (ICE) vs 22.5% (CTS), p = 0.33), except there was significantly longer total ischemic time in transplants using CTS by 26 minutes (195.2 vs 221.2 minutes, p = 0.004) and distance traveled to procure the organs was 44% farther (251.6 vs 445.7 miles, p < 0.001, ICE vs CTS, respectively). Post-transplant, the incidence of severe PGD was similar (11.7% vs 7.8%, p = 0.29, ICE vs CTS, respectively), as was the total length of ICU and hospital stay. The CTS cohort demonstrated a significant improvement in both 30 day (95% vs 100%, p = 0.01) and in-hospital survival (92.6% vs 99.3%, p = 0.005, ICE vs CTS, respectively). Conclusions: Despite significantly longer ischemic times, use of the SherpaPak CTS resulted in improved early survival when compared to heart transplants using standard ice transport.