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J Thorac Cardiovasc Surg 2004;128:352-353
© 2004 The American Association for Thoracic Surgery

Editorial

Gender and lung transplantation: Size matters, does sex?

^a Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa, USA
^b Department of Surgery, Upstate Medical University, Syracuse, NYUSA

Received for publication May 18, 2004; accepted for publication May 24, 2004.

^* Address for reprints: Margaret Blair Marshall, MD, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, 6 Silverstone Pavilion, Philadelphia, PA 19104-4227

The first 20% of the full text of this article appears below.

When evaluating organs for lung-transplant recipients, many issues need to be considered. Donor factors play a key role in the evaluation of organs for transplantation: age, medical history, smoking history, adequate gas exchange, normal bronchoscopy, serologies, ABO compatibilities, and size matching. Donor and recipient gender are neither directly considered nor matched. Should they be? Do the inherent differences between men and women matter in lung transplantation?

There are several reasons to expect a difference when transplanting across organ and recipient gender. Gender-associated differences could play a role in terms of graft survival, organ size, metabolic demands, circulating hormones, and receptors. There are gender-associated immunologic phenomena, such as the female's ability to tolerate certain alloantigens during pregnancy. Does this affect graft survival? Does the fact that women are more susceptible to autoimmune disease play a role in tolerance? For lung transplantation, the data are relatively sparse. However, differences observed in other transplanted organs might give us a clue.

With respect to kidney transplantation, Inoue and colleagues¹ examined 205 kidney transplantations performed over a 13-year period and found that long-term graft survival was better in female than in male recipients. Cyclosporine (INN: ciclosporin) troughs and steroid dosing tended to be lower among female recipients. When graft survival was analyzed among . . . [Full Text of this Article]