The role of estrogen, immune function and aging in heart transplant outcomes

Ashley E. Morgan, Elizabeth Dewey, James Mudd, Jill Gelow, Jonathan Davis, Howard K. Song, Frederick A. Tibayan, Castigliano M. Bhamidipati

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)737-743
Number of pages7
JournalAmerican journal of surgery
Issue number4
StatePublished - Oct 2019

ASJC Scopus subject areas

  • Surgery


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