Sex-Specific Considerations in Management and Outcomes of Heart Transplant Recipients.

Just as sex differences have been well described across the spectrum of heart failure care, there are important sex-specific considerations for heart transplantation (HT) candidates and recipients. Data persistently show that 25% to 30% of HT recipients are women, highlighting barriers in referral and waitlist selection. Furthermore, women are more likely to be allosensitized, which may limit potential donors and increase their risk for antibody-mediated rejection in the post-transplant period. Data suggest differential risk by sex for long-term complications including rejection, cardiac allograft vasculopathy, post-transplant malignancy, and renal disease post-HT. In addition, reproductive health for female transplant recipients-including contraception, pregnancy, and breastfeeding-requires complex multidisciplinary planning and considerations. The purpose of the current review is to summarize existing evidence and sex-specific considerations in post-HT management and clinical outcomes, highlight ongoing gaps in the literature, and propose strategies for improving equity in access and post-HT outcomes.