AN EVALUATION OF RACIAL DISPARITIES IN HEART TRANSPLANTATION OUTCOMES

Abstract

Background Racial disparities affect orthotopic heart transplant (OHT) outcomes. We sought to evaluate contemporary trends and impact of the new 2018 allocation system. Methods Adult single organ OHT recipients from 2011-2020 were identified in the United Network for Organ Sharing database and stratified by race: white, black, Hispanic. The new allocation system began on October 18, 2018. We analyzed recipient and donor characteristics, waitlist and post-transplantation outcomes. Results We identified 32,353 patients (66% white, 25% black, 9% Hispanic) during the study period. Black and Hispanic patients were younger, more likely to be female and have a history diabetes and end-stage renal disease, while white patients were more likely to have private insurance and a history of previous cardiac surgery, malignancy, and tobacco use (all, p<0.05). Considering medical support at listing, black and Hispanic patients were more likely to require inotropes and intra-aortic balloon pump while a higher proportion of white patients underwent extracorporeal membrane oxygenation (all, p<0.05). Fewer black patients were transplanted relative to whites (adjusted HR 0.85, confidence interval (CI) 0.82-0.88, p<0.001), but there was no racial difference in waitlist death (p>0.05). Hispanics had a higher risk of post-transplant death relative to white patients (aHR 2.13, CI 1.10-4.13), but there was no difference for black patients. Over time, the proportion of transplanted black and Hispanic patients increased from 21.7% to 28.2% and 7.7 to 9.0%, respectively, (p<0.001). Following the allocation system change, waitlist times decreased for all cohorts (p<0.001). In addition, the proportion of patients transplanted increased and waitlist death decreased for white and black patients (both, P<0.05), but not Hispanic patients (both, p>0.05). Conclusion Fewer black patients were transplanted, but there was no difference in waitlist or post-transplant death. Listing and transplant racial disparities have narrowed, and more so in 2018, with the new allocation system. However, Hispanic patients have a higher risk of post-transplant death, suggesting more work to reduce disparities remains.