Abstract
BACKGROUND: Lung transplantation 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 lung transplantation pathway. METHODS: We used data from the French COhort in Lung Transplantation (COLT) study (12 participating lung transplantation centres). 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-transplantation class I anti-human leukocyte antigen antibodies were identified as independent factors associated with longer waiting time duration. Female transplant 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 total lung capacity (pTLC) ratio and weight mismatch) did not have worse survival. The overall post-transplantation 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 lung transplantation outcomes did not differ according to gender. CONCLUSION: Women waited longer and were less likely to undergo transplantation. 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.