Purpose of review: The impact of donor and recipient sex on outcome after heart transplantation (HTx) is discussed controversially. Therefore, the recent findings in this field were reviewed.
Recent findings: The combination male recipient/female donor increases the risk for early mortality, whereas other sex constellations yield similar outcomes after HTx. In the long-term follow-up, survival of female recipients is superior, especially in the combination female recipient/female donor. Female recipients of male donor hearts are more susceptible to cellular rejection episodes. Their superior long-term outcome, however, is not affected by that.
Summary: Sex matching in HTx, although desirable, is not always possible without prolonging waiting times for the desired donor heart. The combination female donor-male recipient should be evaluated with caution.