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Racial disparity observed in survival after heart transplantation
Liu V. Circulation. 2011;123:1642-1649.
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During a 22-year interval, black recipients of a heart transplant had higher rates of mortality compared with white recipients, according to retrospective cohort study data.
The study included 39,075 adult recipients of a heart transplant between 1987 and 2009. Among this population, 79.3% of the recipients were white and 12.8% black, with the remaining 7.9% either Latino, Asian, American Indian or Alaskan native, Pacific Islander or multiracial; although the number of nonwhite recipients increased over time.
Overall, median waiting list time was 66 days for nonwhite recipients vs. 92 days for white recipients. There were 16,880 total deaths after transplantation during the study period.
After multivariate adjustment for recipient, socioeconomic and transplant factors, only blacks had an increased mortality risk compared with whites (HR=1.34; 95% CI, 1.21-1.47). This equated to a 5-year mortality rate of 35.7% (95% CI, 35.2-38.3) among blacks and 26.5% (95% CI, 26-27) among whites.
Also, blacks were more likely to die of graft failure or a CV cause than whites (57.9% vs. 37.8%) or other nonwhites (44.1%), but they were less likely to die of an infection or malignancy than whites (19.9% vs. 33%) or other nonwhites (28.2%).
“Although long-term survival has improved for all recipients, the racial gap in survival among blacks has persisted over 2 decades, and may be related in inadequate immunosuppression,” the researchers concluded. “Additional research aimed at identifying the source of this disparity is necessary.”
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These are extremely interesting observations. The difference in outcomes between white and black heart transplant recipients is substantial. Moreover, graft failure and CV causes appear to be the cause although the mechanism(s) involved remain speculative. Given the high and increasing number of blacks who receive heart transplants in the US each year, these results provide strong motivation for further research efforts directed at identifying the cause of the higher rate of graft failure in blacks and, most importantly, providing direction for new treatment algorithms to solve this problem.
– Barry Greenberg, MD
Cardiology
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