Race disparities persist for stroke outcomes after pediatric cardiac transplant
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Among pediatric cardiac transplant recipients who experience perioperative stroke, Black children are three times more likely to die beyond 6 months compared with white children, according to data from a registry analysis.
In a database analysis of pediatric transplants in the United States, researchers also found that Black children have a lower incidence of stroke after cardiac transplant compared with white children, and that mortality among survivors of perioperative stroke is initially similar by race and ethnicity.
“Black children have a threefold higher long term-mortality risk after post-cardiac transplant stroke compared with white children, which is higher than the twofold higher long-term mortality following cardiac transplant alone,” Laura Lehman, MD, MPH, attending in neurology at Boston Children’s Hospital and assistant professor at Harvard Medical School, told Healio. “As clinicians, we need to be aware of the existence of racial disparities in children with stroke after cardiac transplant to work toward the ultimate goal of eliminating disparities.”
Lehman and colleagues analyzed data from 8,224 children who underwent their first heart transplant in the United States from 1994 to September 2019, using the Scientific Registry of Transplant Recipients (SRTR). Researchers assessed the association between race and ethnicity and perioperative stroke, as well as the association between race and ethnicity and mortality among survivors of perioperative stroke.
The findings were published in the Journal of the American Heart Association.
Within the cohort, 3% of children had a stroke during their transplant or before discharge for the hospitalization. The mean age of Black children was 7 years; the mean age of white and Hispanic children was 4 and 5 years, respectively.
Researchers found that Black children had 32% lower odds of perioperative stroke compared with white children, for an adjusted OR of 0.68 (95% CI, 0.46-0.996). After perioperative stroke, mortality rates were similar for Black and white children during the first 6 months (aHR = 0.99; 95% CI, 0.44-2.26). Beyond 6 months, Black children had a threefold higher mortality rate than white children (aHR = 3.36; 95% CI, 1.22-9.22).
“These results were surprising given the previously reported higher rate of pediatric stroke among Black children compared with white children,” the researchers wrote. “This may be because of a selection of healthier Black children receiving transplants, which is not as common among white children. In a recent SRTR study, Black children had a 25% higher mortality rate while on the transplant waitlist compared with white children. This may suggest that Black children at higher risk of perioperative stroke are less likely to survive to receive a heart transplant than white children on the transplant waitlist. Therefore, among waitlist survivors, the (lower risk) Black recipients had a lower rate of perioperative stroke compared with white children.”
The researchers wrote that the higher mortality rate among Black children may be due to discrimination in the physical environment and health care system while on a transplant waitlist, during hospitalizations and during follow-up.
“Next steps would include examining the selection process for transplant listing,” the researchers wrote. “Further interventions are needed to address inequities among cardiac transplant recipients.”
For more information:
Laura Lehman, MD, MPH, can be reached at laura.lehman@childrens.harvard.edu; Twitter: @BostonChildrens.
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