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Heart Transplant Age and Race Disparity
Quick Takes
- Survival after heart transplant (HT) varies based on age, with young Black heart recipients aged 18-30 having nearly twice the risk of death compared to young non-Black recipients after adjustment for recipient, donor, and transplant characteristics.
- This has been masked in decades of research looking at the disparities between Black and non-Black recipients in aggregate.
- Clinical decision making and trials should be better individualized to reduce longstanding disparities in HT outcomes.
Study Questions:
What is the association between recipient race and post-transplant mortality varied by recipient age?
Methods:
The investigators studied 22,997 adult heart transplant (HT) recipients using the Scientific Registry of Transplant Recipients data from January 2005-2017 using Cox regression models adjusted for recipient, donor, and transplant characteristics. Based on the Kaplan-Meier curves showing potential nonproportional hazards at 1 year post-transplant among recipients aged 18-30 years, the authors calculated time-varying hazard ratios associated with Black race in the first year and after the first year post-transplant, with a single Cox regression model per age category.
Results:
Among recipients aged 18-30 years, Black recipients had 2.05-fold (95% confidence interval [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 31-40 and 41-60 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 61-80 years, no significant association was seen with Black race (adjusted hazard ratio, 1.12 [95% CI, 0.97-1.29]; p = 0.1).
Conclusions:
The authors concluded that young Black recipients have a high risk of mortality in the first year after HT, which has been masked in decades of research looking at disparities in aggregate.
Perspective:
This national registry study of adult HT recipients reports that survival after HT varied based on age, with young Black heart recipients aged 18-30 having nearly twice the risk of death compared to young non-Black recipients after adjustment for recipient, donor, and transplant characteristics. This has been masked in decades of research looking at the disparities between Black and non-Black recipients in aggregate. Clinical decision-making and trials should be better individualized based on the unique set of risk factors mediating higher risk of mortality among young Black recipients including immunosuppression, socioeconomic barriers to care, and adherence to reduce longstanding disparities in HT outcomes.
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant
Keywords: African Americans, Cardiac Surgical Procedures, Health Services Accessibility, Heart Failure, Heart Transplantation, Immunosuppression, Risk Factors, Secondary Prevention, Socioeconomic Factors, Tissue Donors, Transplantation
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