Heart transplant rates were markedly lower in women than men, but women were more likely to survive after transplantation, according to data from a large, urban center. 

The findings were presented during a poster session at the Heart Failure Society of America (HFSA) 2025 Annual Scientific Meeting by Lauren M. Kim of Augusta University, Athens, Georgia. 

“We looked through the national proportion of recipients between the years 2012 and 2022 and saw that there were significant increases in the transplant population,” Kim, who is in her third year of medical school, told Medscape Medical News. 

During that timeframe, the researchers noted increases in heart transplant rates in Black (19.7% to 27%) and Hispanic (7.9% to 11.2%) populations, along with people aged 18-34 years (10.9% to 12.5%) and 65 years or older (17.8% to 20.3%). The lack of difference in heart transplant rates in women (27.7% to 26.9%), however, prompted the study. 

“So, we're thinking, ‘What could contribute to that?’” Kim said, noting that historically, differences between women and men have been “a theme in medicine.”

Gender-Based Disparities

The present study was a retrospective analysis of heart transplant recipients at a large, urban community center from 2012 to 2024. The researchers adjusted for a number of variables, including recipient age, gender, BMI, race, length of stay, ischemia time risk category, United Network for Organ Sharing allocation system, and post-transplant extracorporeal membrane oxygenation use.

Primary outcomes were survival, length of stay, and readmission rates.

Of the 285 heart transplant recipients, 72% were men. After transplantation, women had better outcomes at both 1 year (92.2% vs 89.3%) and 2 years (90% vs 83.9%), whereas men had a higher mortality rate (hazard ratio, 1.89; 95% CI, 0.88-4.04).

The findings are somewhat consistent with previous publications and national trends, according to the researchers. “However, our center reports a higher survival rate for women post-transplant compared to national data,” they noted in the abstract.

Ersilia M. DeFilippis, MD, an assistant professor of medicine and advanced heart failure and transplant cardiologist at Columbia University Irving Medical Center in New York, told Medscape Medical News that women are less likely to be referred for advanced therapies and often present for evaluation at a later stage of disease. 

“The improved outcomes seen in this study among women may also reflect selection bias whereby women are held to a ‘higher standard’ for listing,” DeFilippis said.

“In the next steps, we want to see specific things, like are there differences in risks and disparities in general within the medical system or the referrals, like referring the [male] patients out and finding those patients earlier?” Kim said.

“There’s a lot to it,” she continued. “It's not just black and white. And then there are other things: Is the prevalence equal between men and women, and just men get referred more, or is there a difference by gender?”

Additional Considerations

DeFilippis noted some limitations with the study, including its single-center nature. She also highlighted the researchers’ evaluation of length of stay and readmissions as outcomes without reporting them. 

“Of course, mortality is only one important outcome and time at home and quality of life are also important outcomes to consider,” she said. “For example, women are more likely to be sensitized than men, which leads to a higher risk of antibody-mediated rejection in the post-transplant period. Recognizing that this is an abstract, I would be curious to know how outcomes like rejection, hospitalization, and infection compared between men and women.” 

As a final word to cardiologists, DeFilippis said that “it is imperative to remember that referral to an advanced heart failure provider is the first step in improving sex-specific outcomes.”

DeFilippis reported no relevant conflicts of interest. No disclosures were reported for Kim in the study’s abstract or poster.

Brian Ellis is a freelance writer and editor who lives in Southwest Virginia.