Women less likely to get lung transplant than men and they wait longer for surgery, reveals research

Women are less likely to receive a lung transplant and spend an average of six weeks longer on the waiting list, according to a study published in ERJ Open Research. However, women who receive a lung transplant are more likely than men to live for five years post-transplant. Based on their findings, the researchers encourage changes in regulation and clinical guidelines to address this inequality.

Lung transplantation is the only treatment for people with end-stage respiratory failure and patients on the waiting list have a high risk of death. A transplant can restore normal lung function, giving patients an improved life expectancy and higher quality of life.

The lead researcher of the study, Dr Adrien Tissot from Nantes University Hospital, France, said: “It is important to understand that people on the waiting list for a transplant have a very poor quality of life, sometimes they are not well enough to leave their house, and have a high risk of death.

“For these patients, waiting is suffering, and the longer the wait the worse these women are suffering.”

The study included 1710 participants – 802 women and 908 men – who were being cared for at one of France’s 12 transplantation centres between 2009 and 2018. Patients were followed-up for around six years after transplantation. The main underlying diseases affecting patients were chronic obstructive pulmonary disease, cystic fibrosis and interstitial lung disease.

This study is the first to analyse all three periods of the transplantation pathway in the same group of patients: the period on the waiting list prior to transplantation; the transplantation surgery and immediately afterwards; and the months and years after transplantation.

Dr Tissot’s research found that women wait 115 days for a lung transplant on average versus 73 days for men. Women were also less likely to receive a lung transplant (91.6% vs. 95.6%). Previous research has shown that women are also more likely to die on the waiting list.

After transplantation, survival was higher for women than men with 70% of female recipients still alive five years after transplantation, compared to 61% of male recipients.

The researchers also found that most women received a donor lung that was matched by sex and height. Researchers say this is important since there is a higher number of male donors (56% of donors), and men are 13cm taller than women on average, which means that women may have to wait longer to get a lung transplant from a height-matched recipient. Women who received an ‘oversized’ lung generally did not have worse survival after transplantation, suggesting it may be possible to allow more women to receive male donor transplants. This could address some of the gender inequalities on the waiting list.

Dr Tissot said: “Clinicians, patients and policy makers must acknowledge this gender difference as it’s essential for appropriate action to be taken. Early listing for women or revising 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.”

Dr Michael Perch is the Chair of the European Respiratory Society’s Group on Lung Transplantation and a senior consultant at Rigshospitalet, Copenhagen, Denmark, and was not involved in the research. He commented: “Understanding the gender disparities in transplantation is a crucial first step to making patient care better for women and reducing the time they spend on the waiting list. There could be several reasons why women are waiting an average of six weeks longer than men, 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. It is unacceptable for women to be waiting longer than men for these lifesaving donations, so effective corrective measures must be introduced.”

Reference:

Adrien Tissot Anne-Sophie Coatanea Olivia Rousseau, Increased delay to lung transplantation for women candidates: gender-based disparity matters in the lung transplant trajectory, ERJ Open Research, https://doi.org/10.1183/23120541.00623-2024