Women are waiting longer for lung transplantation than men, a French retrospective study finds, showing changes to clinical guidelines and policies are needed to address gender inequalities.
Lung transplantation is a highly dynamic segment of solid organ transplant, where gender is known to play a central role, the study authors wrote in ERJ Open Research.
Previous research using US lung transplantation data had found women had a lower chance of receiving a transplant than men and waited longer before transplant.
For this study the authors evaluated the differences between men and women before transplantation, during and immediately after surgery and in the months and years following transplantation using data from the French Cohort in lung transplantation (COLT) database – the first to analyse all three periods of the transplantation pathway.
Overall, 1,710 participants (802 women and 908 men) were included in the study, with analysis showing women waited an average of six weeks longer for transplantation, spending 115 days on the transplant list compared with 73 days for men.
Women were less likely than men to undergo transplantation (91.6% vs 95.6%), the data showed.
At the time of registration on the lung transplant list, women were younger than men (47 years vs 54 years) and they displayed fewer comorbidities, including ischemic heart disease and cardiovascular risk factors.
In both genders, the main underlying disease was COPD/emphysema, followed by cystic fibrosis and interstitial lung disease.
Lung transplantation gender differences
In other differences, pre-transplant anti-human leukocyte antigen (HLA) antibodies were more prevalent in women than in men (46% vs 26%) for both class I and class II, with the number of pre-transplant class I anti-HLA antibodies associated with an increased waiting time.
It was also more common for women to receive lungs from height- and sex-matched donors, despite higher female-waiting list mortality and a higher proportion of male donors, the authors wrote.
They stressed that women with oversized lung transplantation, defined by predicted total lung capacity ratio and weight, did not have worse survival, therefore suggesting that size matching criteria could be less stringent.
Post-transplantation, women had a significantly higher survival rate than men, with 34.4% of female recipients dying compared with 42.7% of male recipients.
Survival rates were also higher among women than men at five years post-transplantation (70% vs 61%).
Corrective measures imperative
Study lead author Dr Adrien Tissot of from the Pulmonology Department at Nantes University Hospital, France, said people on the lung transplant waiting list had a poor quality of life and high mortality risk.
‘For these patients, waiting is suffering, and the longer the wait the worse these women are suffering,’ he said.
‘Clinicians, patients and policy makers must acknowledge this gender difference as it’s essential for appropriate action to be taken.’
Dr Tissot suggested early listing for women or revising the allocation policy of donor lung to recipient could be considered.
‘We believe our findings, such as the potential role of size matching and its consequence on access to lung transplantation, and length of time on the waiting list, may also apply in other countries where lung transplantation is performed,’ he said.
Also commenting on the findings, Dr Michael Perch, chair of the European Respiratory Society’s Group on Lung Transplantation and a senior consultant at Rigshospitalet in Copenhagen, Denmark, said there could be several reasons why women waited longer for transplantation, including differences in education and health literacy, socioeconomic differences, immunological factors and donor-recipient size matching.
‘Clinicians and policymakers alike must question why there is a focus on gender and size matching in transplantation when evidence shows that, in lungs, these factors do not determine a woman’s chance of survival, and it ultimately risks an increase of women dying while waiting for a transplant,’ he said.
‘It is unacceptable for women to be waiting longer than men for these lifesaving donations, so effective corrective measures must be introduced.’
