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. 2016 Aug;35(8):953-61.
doi: 10.1016/j.healun.2016.01.1231. Epub 2016 Feb 12.

Racial and ethnic disparities in outcomes after heart transplantation: A systematic review of contributing factors and future directions to close the outcomes gap

Alanna A Morris  1 , Evan P Kransdorf  2 , Bernice L Coleman  3 , Monica Colvin  4
Affiliations

Racial and ethnic disparities in outcomes after heart transplantation: A systematic review of contributing factors and future directions to close the outcomes gap

Alanna A Morris et al. J Heart Lung Transplant. 2016 Aug.

Abstract

The demographics of patients undergoing heart transplantation in the United States have shifted over the last 10 years, with an increasing number of racial and ethnic minorities undergoing heart transplant. Multiple studies have shown that survival of African American patients after heart transplantation is lower compared with other ethnic groups. We review the data supporting the presence of this outcome disparity and examine the multiple mechanisms that contribute. With an increasingly diverse population in the United States, knowledge of these disparities, their mechanisms, and ways to improve outcomes is essential.

Keywords: LVAD; cardiomyopathy; health disparities; heart transplantation; race/ethnicity.

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Figures

Figure 1.
Figure 1.. States with greater than average racial/ethnic minority population.
In this map of the US, states are colored if their population of Hispanic/Latino, African American, or Asian persons is greater than the national mean for that group (mean for Hispanic/Latino 16.3%, African American 13.6%, and Asian 5.6%). States with intermediate colors contain two groups at greater than the national average.
Figure 2.
Figure 2.. Disparities in outcome for African American and Hispanic/Latino patients have increased over time.
Racial disparities for the risk of death or retransplantation, conditional on surviving the first 6 months after heart transplant, are widening over progressive eras. The reference group is white heart transplant recipients. The hazard ratios and 95% confidence intervals are adjusted for baseline risk factors. Source, Singh et al.
Figure 3.
Figure 3.. African American and Hispanic/Latino persons have a higher HLA haplotypic diversity as compared to Caucasian and Asian persons.
The first 25 ranked haplotypes in each racial/ethnic group are graphed against the frequency of that haplotype on a logarithmic scale. The frequency of each HLA haplotype is higher for Caucasians and Asians, indicating that the HLA haplotypes of African Americans and Hispanic/Latinos are overall less frequent and therefore more diverse. Source: Maiers et al.
Figure 4.
Figure 4.. Graft survival in heart transplant recipients by recipient ethnicity and PRA level.
Kaplan-Meier curve showing graft survival in heart transplant recipients stratified by recipient ethnicity and PRA level (<10% or ≥10%). African American recipients with PRA ≥10% had the lowest graft survival, whereas Asian recipients with PRA <10% had the highest graft survival. Source Morris et al.
See this image and copyright information in PMC

References

    1. Allen JG, Weiss ES, Arnaoutakis GJ, Russell SD, Baumgartner WA, Conte JV, Shah AS. The Impact of Race on Survival After Heart Transplantation: An Analysis of More Than 20,000 Patients. The Annals of Thoracic Surgery. 2010;89(6):1956–1964. - PubMed
    1. Singh TP, Almond C, Givertz MM, Piercey G, Gauvreau K. Improved Survival in Heart Transplant Recipients in the United States: Racial Differences in Era Effect. Circulation: Heart Failure. 2011;4(2):153–160. - PMC - PubMed
    1. Morris AA, Cole RT, Veledar E, Bellam N, Laskar SR, Smith AL, Gebel HM, Bray RA, Butler J. Influence of Race/Ethnic Differences in Pre-Transplantation Panel Reactive Antibody on Outcomes in Heart Transplant Recipients. Journal of the American College of Cardiology. 2013;62(24):2308–2315. - PubMed
    1. Higgins RSD, Fishman JA. Disparities in Solid Organ Transplantation for Ethnic Minorities: Facts and Solutions. American Journal of Transplantation. 2006;6(11):2556–2562. - PubMed
    1. Smedley A, Smedley B. Race in North America: the Origin and Evolution of a Worldview. Fourth Edition ed: Westview Press; 2012.

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