- Email: [email protected]
577 “Let's Twist Again”: Surgically Induced Renewal of Left Ventricular Torsion in Ischemic Cardiomyopathy
Abstracts
S193
significantly after sildenafil initiation in group 1. At 3 months and at one year after OHT,hemodynamics, graft function and survival were similar between all groups. Table Group 1 n⫽ 8
Group 2 n⫽8
Control n⫽7
Age (yrs) 55.8 ⫾ 10.0 49.5 ⫾ 14.0 53.4 ⫾ 13.2 Donor Age 22.8 ⫾ 4.7* 41.0 ⫾ 14.0 21.9 ⫾ 5.7 ACE/ARB 62.5 75 42.9 Hydralazine/Nitrate 75 62.5 42.9 IT (minutes) 243.5 ⫾ 22.1‡ 192.5 ⫾ 67.5 159.3 ⫾ 70.2 (mean ⫾ standard deviation or %), *p⬍0.05 group1 vs group2, ‡
p⬍0.05 group1 vs control
Conclusions: Patients with no restrictive pattern in PFT have better survival prognosis than the PeakVO2 result suggests. 576
Conclusions: Sildenafil therapy in OHT recipients with nrPTH improved their cardiac transplantation candidacy with similar post-OHT outcome compared to the other OHT recipients, larger studies are needed to validate these results.
Green Tea Reduces Left Ventricular Myocardial Mass in Patients with Transthyretin Amyloidosis A.V. Kristen,1 S. Lehrke,1 D. Mereles,1 P.A. Schnabel,4 C. Röcken,3 P. Ehlermann,1 T.J. Dengler,1 K. Altland,2 H.A. Katus.1 1Department of Cardiology, University of Heidelberg, Heidelberg, Germany; 2Human Genetics, University of Giessen, Giessen, Germany; 3Department of Pathology, University of Kiel, Kiel, Germany; 4Department of Pathology, University of Heidelberg, Heidelberg, Germany.
575 Absence of Restrictive Pattern in Spirometry (PFT) Predicts Good Survival in Chronic Heart Failure (CHF) Patients with Peak Oxygen Consumption(PekVO2) below the Cutoff Point for Heart Transplantation Listing M.K. Lizak,1 M. Zakliczynski,2,3 A. Jarosz,3 M. Zembala,2,3 Z. Kalarus.1,3 1Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Centre for Heart Disease, Zabrze, Silesia, Poland; 2Department of Cardiac Surgery and Transplantology, Silesian Centre for Heart Disease, Zabrze, Silesia, Poland; 3Silesian Medical University, Zabrze, Silesia, Poland. Purpose: Prognostic value of restriction in PFT is poorly documented in CHF. Utility of Lower Limit of Normal (LLN) based PFT interpretation in CHF has not been evaluated yet. We examined the impact of restrictive pattern in PFT defined by classic or LLN criteria on mortality in CHF pts with PeakVO2ⱕ12ml/kg/min. Methods and Materials: 108 CHF pts on chronic -antagonist treatment with PeakVO2ⱕ12ml/kg/min (89 men, 53⫾8 years, BMI 26⫾4; LVEF 24⫾8%, 62% ischemic) divided into groups based on spirometry: Group 1 (N⫽52) – classic criteria: no restrictive pattern, Group 2 (N⫽26) – classic criteria: restrictive pattern present, Group 3 (N⫽34) – LLN criteria: no restrictive pattern, Group 4 (N⫽31) – LLN criteria: restrictive pattern present, Control group (CG, N⫽30) - PeakVO2⬎20ml/kg/min, no restrictive pattern (classic criteria) or obturation (FEV1%FVCⱖ70). Restrictive pattern: classic criteria - FEV1%FVCⱖ70 and IVC%⬍70, LLN criteria - FEV1%FVCⱖLLN and IVC⬍LLN. LLN is the 5th percentile of PFT values’ normal distribution in a reference population, specific to age, sex and height. Observation time: 2000-2008; start: day of CPET and PFT evaluation; end: death. End-points: time to death, 1 and 2-years mortality. Chi-square test, U Mann-Whitney test and Kaplan-Meier survival curves analysis were performed. P⬍0.05 was significant. Results: Survival time was significantly shorter in groups 1,2 and 4, but not 3 compared to the CG (Figure 1). 1-year mortality in groups 1 (9.6%) and 3 (11.8%) did not differ significantly from the CG (0%).
Purpose: Cardiac involvement is common in both forms of transthyretin (TTR) amyloidosis, variant and non-variant (senile) form. As no medical treatment is available yet liver transplantation is the only accepted treatment for patients with variant TTR amyloidosis and mild cardiac involvement, but not for patients with senile amyloidosis. In patients with advanced cardiac amyloidosis heart transplantation is the only available treatment option. In 2007, a patient having AL amyloidosis described a decrease of his LV wall after daily consumption of 2 l of green tea (Hunstein, Blood 2007 110:2216). This prospective, open-label, single center interventional trial was performed to confirm the observation in patients with amyloid TTR cardiomyopathy. Methods and Materials: 19 patients with cardiac TTR amyloidosis were evaluated by standard blood tests, echocardiography, and cardiac MRI (n⫽9) while consuming green tea and/or green tea extract for 12 months. 5 patients were not followed-up for reasons of death (n⫽2), poor health (n⫽2), and heart transplantation (n⫽1). Results: After consumption of green tea and or/green tea extract for 12 months a significant average decline of LV myocardial mass was observed by echo (-15%) and MRI (-10%) accompanied by an increase of mitral annular systolic velocity (9%). In 11 of 14 (79%) patients we observed a reduction of cardiac mass by echo and by MRI in 9/9 (100%) suggesting a loss of cardiac amyloid. In all 14 patients total cholesterol (191.9⫾8.9 mg/dL vs. 172.7⫾9.4 mg/dL; p⬍0.01) and LDL cholesterol (105.8⫾7.6 mg/dL vs. 89.5⫾8.0 mg/dL; p⬍0.01) decreased significantly during the observational period. NT-proBNP plasma levels remained unchanged. No serious adverse side-effects were reported by any of the participants. Conclusions: Consumption of green tea and green tea extracts appear to represent a promising therapeutic tool to halt the progression of the amyloid apposition and even decreases the cardiac amyloid load in patients with TTR amyloidosis. Thus, it is a promising treatment approach that might prevent heart transplantation. 577 “Let’s Twist Again”: Surgically Induced Renewal of Left Ventricular Torsion in Ischemic Cardiomyopathy
S194
The Journal of Heart and Lung Transplantation, Vol 30, No 4S, April 2011
M. Cirillo, G. Troise. Heart Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy. Purpose: Myocardial fiber architecture of the left ventricle is an old knowledge but it has never been considered in any surgical restoration technique. We set a new operation procedure aimed to reset fiber orientation to a near-normal disposition and, consequently, to restore left ventricular torsion. Methods and Materials: From May, 2007 to December, 2009, fourteen consecutive patients with ischemic cardiomyopathy were included in this study. All patients underwent the new surgical anterior ventricular restoration named “KISS” (Keep fIbers orientation by Strip patch reShaping) combined with complete coronary revascularization and, when indicated, mitral anuloplasty. The modified technique aims to re-approach residual myocardium, redirecting fiber orientation displaced by infarct scar toward a more physiologic gross disposition. Patients were studied few days before and after the operation with a complete echocardiographical assessment, including speckle tracking analysis. Results: Standard parameters significantly improved after the operation (EDV, p⬍0.001; ESV, p⬍0.001; EF, p⫽0.001) and so did peak systolic apical rotation, peak systolic left ventricular torsion, 2-chamber and 4-chamber longitudinal strain (p⫽0.004, 0.003, 0.02 and 0.01, respectively). Pearson’s correlation between apical rotation and longitudinal strain (2-chamber and 4-chamber) was ⫺0.81 (p⬍0.001) and ⫺0.73 (p⬍0.001), and between torsion and longitudinal strain was ⫺0.77 (p⬍0.001) and ⫺0.78 (p⬍0.001), respectively. Conclusions: This study reveals a never demonstrated potentiality of the left ventricle to restore its peculiar torsion movement by means of this surgical technique aimed to reset its gross anatomical fiber architecture. The lack of a fiber-based restoration technique in up-to-now surgical operations could explain the limitations in efficacy and the wide variability in outcome of this surgery. Its application could widen the potentialities of repairing a failing heart.
578 Primary Graft Dysfunction: Autopsy Data Sheds Light on Pathogenesis M. Kittleson, J. Patel, F. Esmailian, A. Trento, R. Kass, M. Kawano, Z. Goldstein, M. Rafiei, L. Czer, M. Hamilton, J. Kobashigawa. CedarsSinai Heart Institute, Los Angeles, CA. Purpose: The incidence of primary graft dysfunction (PGD) after heart transplantation (HT) ranges between 10 and 40%. PGD may be due poor preservation, ischemic injury, circulating toxins, or prolonged cold ischemic time. The purpose of this study was to assess the incidence and outcomes of HT recipients with PGD at our center. Methods and Materials: We reviewed 1090 patients(pts) post HT from 1997-2009 for PGD, and compared them to pts without PGD. We defined PGD as pts requiring pressor support, intra-aortic balloon pump, or ECMO support within 24 hours of transplant. We assessed 5-year survival, freedom from cardiac allograft vasculopathy (CAV, stenosis ⬎ 30%), freedom from non-fatal major adverse cardiac events (NF-MACE, defined as MI, CHF, PCI, ICD, stroke, or new PVD), and 1st-year freedom from anytreated rejection. Results: There were 43 (4%) pts who met criteria for PGD compared to 1047 control pts. Pts with PGD had significantly lower 30-day survival, (70% vs. 98%, p⬍0.001), 1 year survival (58% vs. 90%, p⬍0.001) and 5-year survival (40% vs. 80%, p⬍0.001). However, 5-year freedom from CAV, freedom from NF-MACE, and 1st-year freedom from any-treated rejection were comparable between PGD and control pts. Of the 12 pts with PGD who died in the first 30 days, 5 pts had autopsies which revealed severe coronary artery disease (CAD) (n⫽4) with no evidence for cellular or humoral rejection (n⫽5). In several cases, significant perioperative bleeding resulted in severe hypotension (n⫽4).
Conclusions: PGD places pts at significant risk for early mortality. Occult donor CAD and hypotension from perioperative bleeding may be implicated in some pts with PGD. Careful selection to avoid donors with CAD and prevention of perioperative bleeding may reduce the incidence of PGD. 579 Do Boys and Girls Match? – The Effect of Gender Mismatch in Cardiac Transplantation A.Z. Aliabadi, D. Dunkler, F.A. Eskandary, C. Pelanek, T. Haberl, S. Sandner, D. Zimpfer, G. Laufer, A.O. Zuckermann. Cardiac Surgery, Medical University of Vienna, Vienna, Austria. Purpose: The effect of gender matching after cardiac transplantation is still controversial. There is no data about the effect of gender matching on acute rejection and graftvasculopathy. This analysis examines the impact of gender matching on immunological complications after cardiac transplantation. Methods and Materials: A total of 1079 primary adult cardiac transplant patients, transplanted in a single center between 1984-2009 were analysed. Patients were examined according their gender match (recipient/donor): M/M, M/F, F/M, F/F. Demographic data, potential risk factors, freedom from rejection, graftvasculopathy and survival were analysed. Variables were tested with t-test/Wilcoxon test, Chi2 test and Log rank test (Kaplan Meier analysis). A p-value ⬍0.05 was defined as significant. Results: Female patients had significantly lower BMI’s than male patients (23.3⫾3.7 vs 24.8⫾3.2; p⬍0001). Similar, female donor BMI was lower (22.8⫾3.0 vs 24.8⫾3.2; p⬍0.001).Indication for transplantation was different between male (CMP: 60%, ICD 36%, other 4%) and female (CMP: 58%, ICD 29%, other 13% patients (⬍0.001). Median follow-up was 162 months. Gender mismatch had also no impact on survival: M/F (5a:64%, 10a:50%), F/M (5a:71%, 10a:55%), M/M (5a: 69%, 10a:56%), F/F (5a:72%, 10a:60%). There was a higher rejection incidence in mismatch patients: F/M and M/F (both 22%) versus M/M (14%) and F/F (19%; p⫽0.029). Gender mismatch patients (F/M: 5a: 19%, 10a:32%; M/F: 5a:27%, 10a:46%). had a higher incidence of graftvasculopathy compared to gender matched patients (F/F: 5a:9%, 10a:15%; M/M: 5a:23%, 10a:38%; p⬍0.001). F/M mismatch patients ad a higher incidence death from late rejection (11.4% vs 3.1%; p⬍0.001), whereas M/F patients had a higher risk to die from infection (8.6% vs. 2.7%; p⫽0.01). Conclusions: Gender-mismatched patients had a significantly higher incidence of rejection episodes and graftvasculopathy. There seems to be a negative immunological impact of gender mismatch. However this does not have an impact on long-term survival.
S193
significantly after sildenafil initiation in group 1. At 3 months and at one year after OHT,hemodynamics, graft function and survival were similar between all groups. Table Group 1 n⫽ 8
Group 2 n⫽8
Control n⫽7
Age (yrs) 55.8 ⫾ 10.0 49.5 ⫾ 14.0 53.4 ⫾ 13.2 Donor Age 22.8 ⫾ 4.7* 41.0 ⫾ 14.0 21.9 ⫾ 5.7 ACE/ARB 62.5 75 42.9 Hydralazine/Nitrate 75 62.5 42.9 IT (minutes) 243.5 ⫾ 22.1‡ 192.5 ⫾ 67.5 159.3 ⫾ 70.2 (mean ⫾ standard deviation or %), *p⬍0.05 group1 vs group2, ‡
p⬍0.05 group1 vs control
Conclusions: Patients with no restrictive pattern in PFT have better survival prognosis than the PeakVO2 result suggests. 576
Conclusions: Sildenafil therapy in OHT recipients with nrPTH improved their cardiac transplantation candidacy with similar post-OHT outcome compared to the other OHT recipients, larger studies are needed to validate these results.
Green Tea Reduces Left Ventricular Myocardial Mass in Patients with Transthyretin Amyloidosis A.V. Kristen,1 S. Lehrke,1 D. Mereles,1 P.A. Schnabel,4 C. Röcken,3 P. Ehlermann,1 T.J. Dengler,1 K. Altland,2 H.A. Katus.1 1Department of Cardiology, University of Heidelberg, Heidelberg, Germany; 2Human Genetics, University of Giessen, Giessen, Germany; 3Department of Pathology, University of Kiel, Kiel, Germany; 4Department of Pathology, University of Heidelberg, Heidelberg, Germany.
575 Absence of Restrictive Pattern in Spirometry (PFT) Predicts Good Survival in Chronic Heart Failure (CHF) Patients with Peak Oxygen Consumption(PekVO2) below the Cutoff Point for Heart Transplantation Listing M.K. Lizak,1 M. Zakliczynski,2,3 A. Jarosz,3 M. Zembala,2,3 Z. Kalarus.1,3 1Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Centre for Heart Disease, Zabrze, Silesia, Poland; 2Department of Cardiac Surgery and Transplantology, Silesian Centre for Heart Disease, Zabrze, Silesia, Poland; 3Silesian Medical University, Zabrze, Silesia, Poland. Purpose: Prognostic value of restriction in PFT is poorly documented in CHF. Utility of Lower Limit of Normal (LLN) based PFT interpretation in CHF has not been evaluated yet. We examined the impact of restrictive pattern in PFT defined by classic or LLN criteria on mortality in CHF pts with PeakVO2ⱕ12ml/kg/min. Methods and Materials: 108 CHF pts on chronic -antagonist treatment with PeakVO2ⱕ12ml/kg/min (89 men, 53⫾8 years, BMI 26⫾4; LVEF 24⫾8%, 62% ischemic) divided into groups based on spirometry: Group 1 (N⫽52) – classic criteria: no restrictive pattern, Group 2 (N⫽26) – classic criteria: restrictive pattern present, Group 3 (N⫽34) – LLN criteria: no restrictive pattern, Group 4 (N⫽31) – LLN criteria: restrictive pattern present, Control group (CG, N⫽30) - PeakVO2⬎20ml/kg/min, no restrictive pattern (classic criteria) or obturation (FEV1%FVCⱖ70). Restrictive pattern: classic criteria - FEV1%FVCⱖ70 and IVC%⬍70, LLN criteria - FEV1%FVCⱖLLN and IVC⬍LLN. LLN is the 5th percentile of PFT values’ normal distribution in a reference population, specific to age, sex and height. Observation time: 2000-2008; start: day of CPET and PFT evaluation; end: death. End-points: time to death, 1 and 2-years mortality. Chi-square test, U Mann-Whitney test and Kaplan-Meier survival curves analysis were performed. P⬍0.05 was significant. Results: Survival time was significantly shorter in groups 1,2 and 4, but not 3 compared to the CG (Figure 1). 1-year mortality in groups 1 (9.6%) and 3 (11.8%) did not differ significantly from the CG (0%).
Purpose: Cardiac involvement is common in both forms of transthyretin (TTR) amyloidosis, variant and non-variant (senile) form. As no medical treatment is available yet liver transplantation is the only accepted treatment for patients with variant TTR amyloidosis and mild cardiac involvement, but not for patients with senile amyloidosis. In patients with advanced cardiac amyloidosis heart transplantation is the only available treatment option. In 2007, a patient having AL amyloidosis described a decrease of his LV wall after daily consumption of 2 l of green tea (Hunstein, Blood 2007 110:2216). This prospective, open-label, single center interventional trial was performed to confirm the observation in patients with amyloid TTR cardiomyopathy. Methods and Materials: 19 patients with cardiac TTR amyloidosis were evaluated by standard blood tests, echocardiography, and cardiac MRI (n⫽9) while consuming green tea and/or green tea extract for 12 months. 5 patients were not followed-up for reasons of death (n⫽2), poor health (n⫽2), and heart transplantation (n⫽1). Results: After consumption of green tea and or/green tea extract for 12 months a significant average decline of LV myocardial mass was observed by echo (-15%) and MRI (-10%) accompanied by an increase of mitral annular systolic velocity (9%). In 11 of 14 (79%) patients we observed a reduction of cardiac mass by echo and by MRI in 9/9 (100%) suggesting a loss of cardiac amyloid. In all 14 patients total cholesterol (191.9⫾8.9 mg/dL vs. 172.7⫾9.4 mg/dL; p⬍0.01) and LDL cholesterol (105.8⫾7.6 mg/dL vs. 89.5⫾8.0 mg/dL; p⬍0.01) decreased significantly during the observational period. NT-proBNP plasma levels remained unchanged. No serious adverse side-effects were reported by any of the participants. Conclusions: Consumption of green tea and green tea extracts appear to represent a promising therapeutic tool to halt the progression of the amyloid apposition and even decreases the cardiac amyloid load in patients with TTR amyloidosis. Thus, it is a promising treatment approach that might prevent heart transplantation. 577 “Let’s Twist Again”: Surgically Induced Renewal of Left Ventricular Torsion in Ischemic Cardiomyopathy
S194
The Journal of Heart and Lung Transplantation, Vol 30, No 4S, April 2011
M. Cirillo, G. Troise. Heart Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy. Purpose: Myocardial fiber architecture of the left ventricle is an old knowledge but it has never been considered in any surgical restoration technique. We set a new operation procedure aimed to reset fiber orientation to a near-normal disposition and, consequently, to restore left ventricular torsion. Methods and Materials: From May, 2007 to December, 2009, fourteen consecutive patients with ischemic cardiomyopathy were included in this study. All patients underwent the new surgical anterior ventricular restoration named “KISS” (Keep fIbers orientation by Strip patch reShaping) combined with complete coronary revascularization and, when indicated, mitral anuloplasty. The modified technique aims to re-approach residual myocardium, redirecting fiber orientation displaced by infarct scar toward a more physiologic gross disposition. Patients were studied few days before and after the operation with a complete echocardiographical assessment, including speckle tracking analysis. Results: Standard parameters significantly improved after the operation (EDV, p⬍0.001; ESV, p⬍0.001; EF, p⫽0.001) and so did peak systolic apical rotation, peak systolic left ventricular torsion, 2-chamber and 4-chamber longitudinal strain (p⫽0.004, 0.003, 0.02 and 0.01, respectively). Pearson’s correlation between apical rotation and longitudinal strain (2-chamber and 4-chamber) was ⫺0.81 (p⬍0.001) and ⫺0.73 (p⬍0.001), and between torsion and longitudinal strain was ⫺0.77 (p⬍0.001) and ⫺0.78 (p⬍0.001), respectively. Conclusions: This study reveals a never demonstrated potentiality of the left ventricle to restore its peculiar torsion movement by means of this surgical technique aimed to reset its gross anatomical fiber architecture. The lack of a fiber-based restoration technique in up-to-now surgical operations could explain the limitations in efficacy and the wide variability in outcome of this surgery. Its application could widen the potentialities of repairing a failing heart.
578 Primary Graft Dysfunction: Autopsy Data Sheds Light on Pathogenesis M. Kittleson, J. Patel, F. Esmailian, A. Trento, R. Kass, M. Kawano, Z. Goldstein, M. Rafiei, L. Czer, M. Hamilton, J. Kobashigawa. CedarsSinai Heart Institute, Los Angeles, CA. Purpose: The incidence of primary graft dysfunction (PGD) after heart transplantation (HT) ranges between 10 and 40%. PGD may be due poor preservation, ischemic injury, circulating toxins, or prolonged cold ischemic time. The purpose of this study was to assess the incidence and outcomes of HT recipients with PGD at our center. Methods and Materials: We reviewed 1090 patients(pts) post HT from 1997-2009 for PGD, and compared them to pts without PGD. We defined PGD as pts requiring pressor support, intra-aortic balloon pump, or ECMO support within 24 hours of transplant. We assessed 5-year survival, freedom from cardiac allograft vasculopathy (CAV, stenosis ⬎ 30%), freedom from non-fatal major adverse cardiac events (NF-MACE, defined as MI, CHF, PCI, ICD, stroke, or new PVD), and 1st-year freedom from anytreated rejection. Results: There were 43 (4%) pts who met criteria for PGD compared to 1047 control pts. Pts with PGD had significantly lower 30-day survival, (70% vs. 98%, p⬍0.001), 1 year survival (58% vs. 90%, p⬍0.001) and 5-year survival (40% vs. 80%, p⬍0.001). However, 5-year freedom from CAV, freedom from NF-MACE, and 1st-year freedom from any-treated rejection were comparable between PGD and control pts. Of the 12 pts with PGD who died in the first 30 days, 5 pts had autopsies which revealed severe coronary artery disease (CAD) (n⫽4) with no evidence for cellular or humoral rejection (n⫽5). In several cases, significant perioperative bleeding resulted in severe hypotension (n⫽4).
Conclusions: PGD places pts at significant risk for early mortality. Occult donor CAD and hypotension from perioperative bleeding may be implicated in some pts with PGD. Careful selection to avoid donors with CAD and prevention of perioperative bleeding may reduce the incidence of PGD. 579 Do Boys and Girls Match? – The Effect of Gender Mismatch in Cardiac Transplantation A.Z. Aliabadi, D. Dunkler, F.A. Eskandary, C. Pelanek, T. Haberl, S. Sandner, D. Zimpfer, G. Laufer, A.O. Zuckermann. Cardiac Surgery, Medical University of Vienna, Vienna, Austria. Purpose: The effect of gender matching after cardiac transplantation is still controversial. There is no data about the effect of gender matching on acute rejection and graftvasculopathy. This analysis examines the impact of gender matching on immunological complications after cardiac transplantation. Methods and Materials: A total of 1079 primary adult cardiac transplant patients, transplanted in a single center between 1984-2009 were analysed. Patients were examined according their gender match (recipient/donor): M/M, M/F, F/M, F/F. Demographic data, potential risk factors, freedom from rejection, graftvasculopathy and survival were analysed. Variables were tested with t-test/Wilcoxon test, Chi2 test and Log rank test (Kaplan Meier analysis). A p-value ⬍0.05 was defined as significant. Results: Female patients had significantly lower BMI’s than male patients (23.3⫾3.7 vs 24.8⫾3.2; p⬍0001). Similar, female donor BMI was lower (22.8⫾3.0 vs 24.8⫾3.2; p⬍0.001).Indication for transplantation was different between male (CMP: 60%, ICD 36%, other 4%) and female (CMP: 58%, ICD 29%, other 13% patients (⬍0.001). Median follow-up was 162 months. Gender mismatch had also no impact on survival: M/F (5a:64%, 10a:50%), F/M (5a:71%, 10a:55%), M/M (5a: 69%, 10a:56%), F/F (5a:72%, 10a:60%). There was a higher rejection incidence in mismatch patients: F/M and M/F (both 22%) versus M/M (14%) and F/F (19%; p⫽0.029). Gender mismatch patients (F/M: 5a: 19%, 10a:32%; M/F: 5a:27%, 10a:46%). had a higher incidence of graftvasculopathy compared to gender matched patients (F/F: 5a:9%, 10a:15%; M/M: 5a:23%, 10a:38%; p⬍0.001). F/M mismatch patients ad a higher incidence death from late rejection (11.4% vs 3.1%; p⬍0.001), whereas M/F patients had a higher risk to die from infection (8.6% vs. 2.7%; p⫽0.01). Conclusions: Gender-mismatched patients had a significantly higher incidence of rejection episodes and graftvasculopathy. There seems to be a negative immunological impact of gender mismatch. However this does not have an impact on long-term survival.