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.
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.
Authors: James F George; Salpy V Pamboukian; José A Tallaj; David C Naftel; Susan L Myers; Margaret T Foushee; Robert N Brown; Octavio E Pajaro; David C McGiffin; James K Kirklin Journal: J Heart Lung Transplant Date: 2010-06-26 Impact factor: 10.247
Authors: Lauren M Kucirka; Morgan E Grams; Justin Lessler; Erin Carlyle Hall; Nathan James; Allan B Massie; Robert A Montgomery; Dorry L Segev Journal: JAMA Date: 2011-08-10 Impact factor: 56.272
Authors: Arman Kilic; Eric S Weiss; Timothy J George; George J Arnaoutakis; David D Yuh; Ashish S Shah; John V Conte Journal: Ann Thorac Surg Date: 2012-01-05 Impact factor: 4.330
Authors: K J Van Arendonk; E A King; B J Orandi; N T James; J M Smith; P M Colombani; J C Magee; D L Segev Journal: Am J Transplant Date: 2015-02 Impact factor: 8.086
Authors: J Jarcho; D C Naftel; T W Shroyer; J K Kirklin; R C Bourge; M L Barr; D G Pitts; R C Starling Journal: J Heart Lung Transplant Date: 1994 Jul-Aug Impact factor: 10.247
Authors: Jeremiah G Allen; Eric S Weiss; George J Arnaoutakis; Stuart D Russell; William A Baumgartner; John V Conte; Ashish S Shah Journal: Ann Thorac Surg Date: 2010-06 Impact factor: 4.330