Is Race a Predictor of Graft Survival in Heart Transplant Patients?

Race/ethnicity and level of sensitization are predictors of graft survival in heart transplant patients, and specifically, Black and Hispanic patients have a higher risk of graft failure post-transplant, with sensitized Blacks having the poorest long-term outcomes, according to a study published Aug. 28 in the Journal of the American College of Cardiology.

“The findings of this study should stimulate additional research and clinical investigation to help determine why there is still a disparity and what measures can be taken to improve the outcomes for these patients,” said Mark Slaughter, MD.

The study looked at 19,704 patients age 18 or older enrolled in the Organ Procurement and Transplantation database identified as White, Black, Hispanic, or Asian. Results showed that Black heart transplant recipients were more likely to experience graft failure than Hispanic, White, or Asian recipients (31 percent vs. 27 percent vs. 26 percent vs. 21 percent, p<0.001). Blacks also had a higher peak panel reactive antibody than all other groups, and were more likely to be sensitized. Sensitized Blacks had the lowest rate of allograft survival, while non-sensitized Asians had the highest survival. Further, using Cox proportional regression to adjust for other clinical variables, Blacks (HR 1.39, 95 percent CI 1.22,1.42), Hispanics (HR 1.12, 95 percent CI 1.01,1.24), and sensitization (HR 1.17, 95 percent CI 1.10,1.25) remained predictors of higher rates of graft failure.

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According to the study authors, their findings “confirm and extend pervious data showing higher mortality in Black and Hispanic heart transplant recipients.” They add that “despite substantial improvements during the current era in the application of human leukocyte antigen technology, clear disparities exist that put certain race/ethnic minorities at higher risk of allograft failure independent of differences in socioeconomic status.” Moving forward, they suggest further studies looking at gaps in post-transplant outcomes.

In an accompanying editorial comment, Sean Pinney, MD, FACC, division of cardiology, Mount Sinai Medical Center agrees, and notes there’s “still a ways to go” despite heart transplant programs’ efforts to overcome racial and ethnic disparities. He suggests a multi-modal approach to care that “typically encompasses aggressive risk factor modification, engages patients and families in disease management programs and provides sufficient levels of immunosuppression to prevent recurrent rejection and graft loss.” This approach “should ensure that all patients enjoy the full promise of heart transplantation regardless of race or ethnicity,” he writes.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Heart Transplant

Keywords: Tissue and Organ Procurement, European Continental Ancestry Group, Disease Management, Risk Factors, Hispanic Americans, Graft Survival, Leukocytes, Social Class, United States, Heart Transplantation

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