Improved Survival in Heart Transplant Recipients in the United States

Abstract

Background Post-transplant survival in heart transplant recipients has progressively improved during the last 2 decades. It is unknown however whether the major racial groups in the United States have benefited equally. Methods and Results We analyzed all primary heart transplant recipients ≥18 years old in the United States during 1987-2008. We compared post-transplant survival in white, black and Hispanic recipients in 5 successive eras (1987-1992, 1993-1996, 1997-2000, 2001-2004, 2005-2008). Early survival was defined as freedom from death or re-transplantation during the first 6-months post-transplant. Longer-term, conditional survival was assessed in patients who survived the first 6 months. There were 29,986 white (81.6%), 4,745 black (12.9%) and 2,017 Hispanic (5.5%) patients in the study cohort. Black patients were at increased risk of early death or re-transplant (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.05, 1.26) in adjusted analysis. Early post-transplant survival improved (HR 0.83, CI 0.80, 0.87 for successive eras) equally in all three groups (P=0.94 for black-era, 0.40 for Hispanic-era interaction). Longer-term survival improved in white (HR 0.95, CI 0.92, 0.97 for successive eras) but not in black (HR 1.04, 95% CI 0.99, 1.09) or Hispanic (HR 1.02, CI 0.95, 1.09) recipients, resulting in increased disparities in longer-term survival with time. Conclusions Early post-transplant survival has improved equally in white, black and Hispanic heart transplant recipients. Longer-term survival has improved in white but not in black or Hispanic recipients resulting in a more marked disparity in outcomes in the current era. These disparities warrant further investigation and targeted interventions.

Racial Disparities in Outcomes of Adult Heart Transplantation

“…2 If black patients are less optimally treated for advanced heart failure, theoretically this could negatively impact immediate and long-term outcomes after transplant. Similarly, access to medical therapy before and after transplantation, socioeconomic status, dietary habits, pharmacokinetics, and genetic expression and polymorphisms could all potentially impact outcomes in blacks with advanced heart failure after transplantation.…”

Racial and Ethnic Differences in Wait-List Outcomes in Patients Listed for Heart Transplantation in the United States

“…Several studies have assessed racial differences in longterm survival among HT recipients and have attributed a higher rate of graft loss in black recipients to immune-related mechanisms. [11][12][13] This is the first study to focus on racial/ ethnic differences in wait-list outcomes. The findings were somewhat unexpected in light of previous observations from several unrelated sources.…”

“…[11][12][13] However, there is limited information regarding racial/ethnic differences in mortality among those awaiting a HT 14 and none in the current era. With a gradual change in US demographics, minorities represent a growing proportion of US population and may be expected to represent a higher percentage of HT candidates over time.…”

“…With a gradual change in US demographics, minorities represent a growing proportion of US population and may be expected to represent a higher percentage of HT candidates over time. 5,12 It is therefore important to know if there are racial/ethnic differences in wait-list mortality in the United States in the current era. Furthermore, because the sicker patients on the HT wait-list may also be at higher risk of early posttransplant mortality, analysis of early posttransplant mortality may provide additional insights into wait-list outcomes.…”

Racial Differences and Racial Disparities

“…[2][3][4] However, on further consideration, the article highlights a more overarching contemporary issue in medicine that requires critical attention. That issue is how we conceptualize and, importantly, use language to describe variation among population groups.…”