Young Black recipients at elevated risk for mortality after heart transplant
In the first year after heart transplant, young Black recipients were at higher risk for mortality than those of other backgrounds, according to findings published in Circulation: Heart Failure.
“This study identified young Black recipients as a high-risk subgroup in the first year after transplant, which has been masked in decades of research looking at the disparities between Black and non-Black recipients in aggregate,” Hasina Maredia, MD, resident physician in the department of surgery at Johns Hopkins University School of Medicine, and colleagues wrote.
Researchers evaluated the Scientific Registry of Transplant Recipients and evaluated data on 22,997 first-time adult heart transplant recipients from 2005 to 2017. In the cohort, 20% of recipients were Black (median age, 51 years; 34% women).
Black heart transplant recipients aged 18 to 30 years demonstrated a 2.05-fold higher risk for mortality compared with non-Black heart transplant recipients of the same age group (P < .001). This risk was significant in the first year after heart transplant (adjusted HR = 2.3; 95% CI, 1.6-3.31; P < .001) but not after the first year (aHR = 0.84; 95% CI, 0.54-1.29; P = .4).
In transplant recipients aged 31 to 40 years, Black recipients also had elevated risk for mortality compared with other recipients (aHR = 1.53; 95% CI, 1.25-1.89; P < .001), and the same was true in those aged 41 to 60 years (aHR = 1.2; 95% CI, 1.09-1.33; P < .001).
However, in recipients aged 61 to 80 years, there was no significant difference in mortality by race (aHR = 1.12; 95% CI, 0.97-1.29; P = .1).
“We should also consider there are differences in the immunity status of persons of African ancestry,” Maria Rose Costanzo, MD, medical director of heart failure research at the Advocate Heart Institute and Edward Hospital Center for Advanced Heart Failure in Naperville, Illinois, told Healio. “There is a more vigorous humoral immunity, which leads to the production of specific anti-donor antibodies that damage the transplanted heart. In addition, there are genetic differences in how individuals metabolize antirejection drugs.”
According to the researchers, current and future clinical drug trials that examine immunosuppression regimens in heart transplant recipients should stratify participants by race and age due to the unique risk factors observed among young Black recipients.
“To eliminate racial disparities in heart transplant outcomes, the attention of future clinical and scientific investigations should focus on improving survival among young Black patients,” the researchers wrote. “Further clinical studies are needed to elucidate mechanistic explanations for lower survival among young Black recipients in the first year after transplant, including immunosuppression, socioeconomic barriers to care and adherence.”
For more information:
Maria Rosa Costanzo, MD, can be reached at mariarosa.costanzo@aah.org.
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