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Comparative Study
. 2011 Mar;4(2):153-60.
doi: 10.1161/CIRCHEARTFAILURE.110.957829. Epub 2011 Jan 12.

Improved survival in heart transplant recipients in the United States: racial differences in era effect

Tajinder P Singh  1 , Christopher Almond, Michael M Givertz, Gary Piercey, Kimberlee Gauvreau
Affiliations
Comparative Study

Improved survival in heart transplant recipients in the United States: racial differences in era effect

Tajinder P Singh et al. Circ Heart Fail. 2011 Mar.

Abstract

Background: Posttransplant survival in heart transplant recipients has progressively improved during the past 2 decades. It is unknown, however, whether the major racial groups in the United States have benefited equally.

Methods and results: We analyzed all primary heart transplant recipients aged ≥18 years in the United States from 1987 to 2008. We compared posttransplant survival in white, black, and Hispanic recipients in 5 successive eras (1987 to 1992, 1993 to 1996, 1997 to 2000, 2001 to 2004, 2005 to 2008). Early survival was defined as freedom from death or retransplantation during the first 6 months posttransplant. Longer-term, conditional survival was assessed in patients who survived the first 6 months. There were 29 986 (81.6%) white, 4745 (12.9%) black, and 2017 (5.5%) Hispanic patients in the study cohort. Black patients were at increased risk of early death or retransplant (hazard ratio [HR], 1.15; 95% CI, 1.05 to 1.26) in adjusted analysis. Early posttransplant survival improved (HR, 0.83; 95% CI, 0.80 to 0.87 for successive eras) equally in all 3 groups (black-era interaction, P=0.94; Hispanic-era interaction, P=0.40). Longer-term survival improved in white (HR, 0.95; 95% CI, 0.92 to 0.97 for successive eras) but not in black (HR, 1.04; 95% CI, 0.99 to 1.09) or Hispanic (HR, 1.02; 95% CI, 0.95 to 1.09) recipients, resulting in increased disparities in longer-term survival with time.

Conclusions: Early posttransplant survival has improved equally in white, black, and Hispanic heart transplant recipients. Longer-term survival has improved in white but not in black or Hispanic recipients, resulting in a more marked disparity in outcomes in the current era. These disparities warrant further investigation and targeted interventions.

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Figures

Figure 1
Figure 1
Early (first 6 months) post-transplant survival in white (A), black (B), and Hispanic (C) heart transplant recipients during the five eras. The improvement in survival in the three groups, adjusted for baseline risk factors, was similar (P=0.94 for black-era and 0.40 for Hispanic-era interaction).
Figure 2
Figure 2
Widening racial disparities for longer-term survival, conditional upon surviving the first 6-month after heart transplant. The reference group is white heart transplant recipients. The hazard ratios and 95% confidence intervals are adjusted for baseline risk factors (see Table 3).
Figure 3
Figure 3
Racial trends in use of tacrolimus (A) and mycophenolate mofetil (B) as maintenance immune suppression at hospital discharge.
See this image and copyright information in PMC

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