Heart transplantation (HT) is the recommended treatment for end-stage heart failure patients who are unresponsive to other medical or surgical interventions. In developed countries, the prevalence of heart failure is 1 %, and out of these, around 10 % of the patients suffer from an advanced stage of the disease and therefore are potential candidates for a cardiac transplant.1 Heart transplant has been used for advanced heart failure treatment in males and females, with an estimated one-year survival of 91 % and a median survival of 12-13 years.2

Females are more likely to be of advanced age and present with more severe heart failure features, including peripheral edema, fatigue, and dyspnea at rest. The female sex has also been found to be an independent prognostic factor for heart failure survival, as the risk of all-cause mortality was significantly lower in females.3 Women constitute less than 25 % of heart transplant recipients.4 A significant number of new candidates are added each year to the National Heart transplant waitlist, and the numbers have demonstrated an upward trend from 2240 in 2005 to 3521 in 2016; however, a significant difference has been reported in the percentages of women as compared to men that are awaiting the transplantation (22 % vs. 78 %).5 In this study, we sought to determine (1) describe temporal trends in heart transplant utilization and (2) clinical characteristics and in-hospital outcomes of these patients stratified by sex.