Can gene-expression profiling score help explain the adverse clinical outcomes seen in gender-mismatched heart transplants?


Aurora Research Institute, St. Luke's Medical Center


Background: Gene-expression profiling (GEP) testing, in conjunction with clinical assessment, is an established laboratory test intended to aid in the identification of acute cellular rejection in heart transplant recipients. In this patient population, donor- and recipient-gender mismatch is a well-known risk factor for adverse outcomes (including survival and rejection). The mechanism for this variant outcome is unclear. The objective of this study was to determine if gender-mismatched heart transplant recipients have different GEP scores.

Methods: Outcomes AlloMap® Registry (OAR) comprises 11 heart transplant centers contributing clinical data on short- and long-term outcomes in heart transplant recipients who receive GEP testing as part of allograft rejection surveillance. All 237 consecutive patients (651 visits) from the OAR were selected for analysis.

Results: Of 237 patients, 216 had both donor- and recipient genders reported. Of those, 76% were Caucasians, and recipient mean age was 56y. 46% had ischemic etiology and 58% were on mechanical circulatory support prior to transplant. There were 46 gender mismatches identified (25 female donor>male recipient & 21 male donor>female recipient). Mean (median) GEP scores for the gender-mismatched group were compared to the non-mismatched group: female>male 27.71 (28), male>female 27.77 (28) vs. male>male 28.76 (30), female>female 27.78 (29). No statistically significant difference was observed in clinical outcomes (heart failure symptoms, hospitalizations, rejection, CMV infection and cancer) in the gender-mismatched cohort; however, there were few of these events.

Conclusion: No significant difference in GEP scores was noted in gender-mismatched heart transplant recipients as compared to gender-matched transplant recipients. A larger sample size is needed to determine significance of these results.

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