Better Understanding the Disparity Associated With Black Race in Heart Transplant Outcomes

Abstract

Background: Black heart transplant recipients have higher risk of mortality than White recipients. Better understanding of this disparity, including subgroups most affected and timing of the highest risk, is necessary to improve care of Black recipients. We hypothesize that this disparity may be most pronounced among young recipients, as barriers to care like socioeconomic factors may be particularly salient in a younger population and lead to higher early risk of mortality. Methods: We studied 22 997 adult heart transplant recipients using the Scientific Registry of Transplant Recipients data from January 2005 to 2017 using Cox regression models adjusted for recipient, donor, and transplant characteristics. Results: Among recipients aged 18 to 30 years, Black recipients had 2.05-fold (95% CI, 1.67–2.51) higher risk of mortality compared with non-Black recipients ( P <0.001, interaction P <0.001); however, the risk was significant only in the first year post-transplant (first year: adjusted hazard ratio, 2.30 [95% CI, 1.60–3.31], P <0.001; after first year: adjusted hazard ratio, 0.84 [95% CI, 0.54–1.29]; P =0.4). This association was attenuated among recipients aged 31 to 40 and 41 to 60 years, in whom Black recipients had 1.53-fold ([95% CI, 1.25–1.89] P <0.001) and 1.20-fold ([95% CI, 1.09–1.33] P <0.001) higher risk of mortality. Among recipients aged 61 to 80 years, no significant association was seen with Black race (adjusted hazard ratio, 1.12 [95% CI, 0.97–1.29]; P =0.1). Conclusions: Young Black recipients have a high risk of mortality in the first year after heart transplant, which has been masked in decades of research looking at disparities in aggregate. To reduce overall racial disparities, clinical research moving forward should focus on targeted interventions for young Black recipients during this period.

Racial Disparities in Post-Transplant Stroke and Mortality Following Stroke in Adult Cardiac Transplant Recipients in the United States

“…1.13 -2.23). Several other studies 7,8,12 that used the same transplant registry and adjusted for education level and insurance type also did not report an attenuation of the association between Black race and mortality. There was no other socioeconomic information available in the SRTR registry, but we aimed to use such information to examine its role as a potential mediator rather than to explain the extent of racial differences by all components of socioeconomic status occurring later in life.…”

“…al. 7 When we adjusted for the setting of long-term follow-up care, the association between race and mortality in post-transplant stroke survivors beyond 6 months was slightly attenuated. This suggests that differences in the setting of care for long-term follow-up may be at least partially responsible for the observed disparities.…”

“…5 In the general population, Black adults have a 3-4 times higher risk of dying from stroke than white adults 6 . Furthermore, among heart transplant recipients, Black adults have a higher mortality rate 7 than patients from other racial/ethnic groups, particularly in the period beyond 6 months following transplant. 5 Although mortality rates among transplant recipients have declined since 1987, the higher mortality rate among Black recipients has persisted 8 .…”

Social Inequalities in Non-ischemic Cardiomyopathies

“…Furthermore, race is considered a critical factor that determines the clinical course after heart transplantation. According to the UNOS registry, after adjusting for recipient, transplant, and socioeconomic factors, Black recipients had a significantly higher risk of posttransplant mortality ( 67 ). Financial limitations might influence the adherence to follow-up visits in the posttransplant period.…”

“…Recently, the SES disparities decreased over time ( 67 ). The gap between the middle and highest classes decreased; however, the lowest SES still exhibited a significant risk over time.…”