Do outcomes for heart transplantation differ based on donor and recipient race?

Autor: Blitzer D; Columbia University, Department of Surgery, Division of Cardiovascular Surgery, New York, New York, USA., Pegues JN; University of Mississippi Medical Center, Department of Surgery, Jackson, Mississippi, USA., Lirette ST; Fulcrum, Jackson, Mississippi, USA., Baran DA; Cleveland Clinic Heart Vascular and Thoracic Institute, Weston, Florida, USA., Colvin M; Department of Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA., Hayanga A; West Virginia University, Department of Cardiovascular and Thoracic Surgery, Morgantown WV, USA., Copeland H; Lutheran Hospital, Fort Wayne, Indiana, USA.; Indiana University School of Medicine - Fort Wayne (IUSM-FW), Fort Wayne, Indiana, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2023 Dec; Vol. 37 (12), pp. e15137. Date of Electronic Publication: 2023 Sep 19.
DOI: 10.1111/ctr.15137
Abstrakt: Purpose: There are limited data examining the impact of both donor and recipient race on outcomes following orthotopic heart transplant (OHT). The purpose of this study was to evaluate the relationship between donor and recipient race and OHT outcomes.
Methods: The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from January 2000 to March 2018 for donor hearts. A comparison was conducted based on donor and recipient race (White, Black, Hispanic, Other/Unknown). Races for which there were limited numbers were excluded from the analysis (Asian, n = 1292; American Indian, n = 132; Pacific Islander, n = 132, Multiple ethnicities, n = 225). The primary endpoint was survival at 30 days, 1 year survival, and post-transplant rejection. Logistic and Cox models were used to quantify survival endpoints.
Results: A total of 41 841 OHT were included. Of the recipients, 29 894 (71%) were White, 8475 (20%) were Black, and 3472 (8%) were Hispanic. Of the donors 27 783 (66%) were White, 6277 (15%) were Black, 6576 (16%) were Hispanic, and 1205 (3%) were Unknown/Other race. In a comparison of recipient demographics, White recipients were older (54.09 ± 12.21 years) compared to Black (49.44 ± 12.83 years) and Hispanic (49.97 ± 13.27 years) recipients. All other differences between groups were not clinically significant. Black recipients were more likely to receive a heart with an "urgent" status (probability .80) compared to White (.73) and Hispanic (.75) recipients (p < .001). Hispanic recipients were more likely to receive a transplant when listed as "non-urgent" (Probability .47) compared to White (.37) and Black (.30) recipients (p < .001). In terms of outcomes, compared to White recipients, Hispanic patients experienced a decreased 30-day survival (OR 1.27; p = .011) and 1-year survival (OR 1.17; p = .016). In comparing Donor/Recipient combinations compared to a White Donor/White Recipient combination, overall survival was decreased in White donor/African American recipient (HR 1.36; p < .001), African American donor/African American recipient (HR 1.41; p < .001) and Hispanic donor/African American recipient (HR 1.30; p < .001) combinations (Table 1).
Conclusions: African American and Hispanic recipients have decreased survival compared to White recipients after heart transplant. The African American donor does not decrease survival. Racial differences still exist in donor and recipient characteristics and recipient outcomes after OHT. Increasing the donor pool for all races and ethnicities would potentially benefit all recipients. Continued study is warranted in order to minimize these differences among recipients and identify factors that could be contributing to decreased survival, in order to optimize outcomes for African American and Hispanic recipients post-transplant and eliminate disparities.
(© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz: