Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan 14;8(1):3.
doi: 10.1186/s13584-018-0271-7.

Ethnic disparity in Israel impacts long-term results after heart transplantation

Yael Peled  1   2 , Ron Loewenthal  3 , Yigal Kassif  4   5 , Eugenia Raichlin  6 , Arwa Younis  4   5 , Anan Younis  4   5 , Eyal Nachum  4   5 , Dov Freimark  4   5 , Jacob Lavee  4   5
Affiliations

Ethnic disparity in Israel impacts long-term results after heart transplantation

Yael Peled et al. Isr J Health Policy Res. .

Abstract

Background: Ethnicity may affect graft longevity and recipient mortality after heart transplantation (HTx). We hypothesized that differences in ethnic origin between Arabs and Jews undergoing HTx in Israel may contribute to differences in long-term outcomes.

Methods: The study population comprised all 254 patients who underwent HTx between 1991 and 2017 in a tertiary medical center located in the center of Israel. Patients were categorized as either Jews (226 patients, 89%) or Arabs (28 patients, 11%). The primary end point was cardiac allograft vasculopathy (CAV), secondary end points were cardiovascular (CV) mortality and the combined end point of CAV/CV mortality.

Results: In comparison with Jews, Arab patients were significantly younger (ave. age 42 vs. 50) and had shorter in-hospital stay (45 vs. 80 days). However, Kaplan-Meier survival analysis showed that at 10 years of follow-up CAV rates were significantly higher among Arabs (58%) compared with Jews (23%; log-rank P = 0.01) for the overall difference during follow-up. Similar results were shown for the separate end point of CV mortality and the combined end point of CAV/CV mortality. Multivariate analysis, which controlled for age, gender, statin treatment, and other potential confounders, showed that Arab recipient ethnic origin was associated with a significant > 2.5-fold (p = 0.01) increase in the risk for CAV; a > 4-fold increase in the risk for CV mortality (p = 0.001); and approximately 4-fold increase in the risk for the combined end point (p = 0.001). These findings were validated by propensity score analysis.

Conclusions: Our data suggest that Arab ethnic origin is associated with a significantly increased risk for CAV and mortality following HTx. Suggested explanations contributing to ethnic disparities in Israel include socioeconomic, environmental and genetic factors. Further studies are required to evaluate whether more aggressive risk factor management in the Israeli Arab population following HTx would reduce CAV and CV mortality in this high-risk population. Increased awareness and early intervention of the Israeli healthcare system and cooperation with the Arab community is of paramount importance.

Keywords: Arabs; Cardiac allograft vasculopathy; Cardiovascular mortality; Ethnicity; Heart transplantation; Jews.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

We do declare that the present study was ethically approved by the ethic committee of Sheba Medical Center.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
CAV survival according to recipient ethnic origin using Kaplan-Meier analysis (a) and propensity score modeling (b)
Fig. 2
Fig. 2
Cardiovascular survival according to recipient ethnic using Kaplan-Meier analysis (a) and propensity score modeling (b)
Fig. 3
Fig. 3
Kaplan Meier survival curve of the combined end point of CAV or CV mortality according to recipient ethnic origin using Kaplan-Meier analysis (a) and propensity score modeling (b)
See this image and copyright information in PMC

Comment in

References

    1. Barnard CN. The operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur hospital, Cape Town. S Afr Med J. 1967;41:1271–1274. - PubMed
    1. Lund LH, Khush KK, Cherikh WS, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-fourth adult heart transplantation Report-2017; focus theme: allograft ischemic time. J Heart Lung Transplant. 2017;36:1037–1046. doi: 10.1016/j.healun.2017.07.019. - DOI - PubMed
    1. Allen JG, Weiss ES, Arnaoutakis GJ, et al. The impact of race onsurvival after heart transplantation: an analysis of more than 20,000 patients. Ann Thorac Surg. 2010;89:1956–1964. doi: 10.1016/j.athoracsur.2010.02.093. - DOI - PubMed
    1. Singh TP, Almond C, Givertz MM, Piercey G, Gauvreau K. Improved survival in heart transplant recipients in the United States: clinical perspective. Circ Heart Fail. 2011;4:153–160. doi: 10.1161/CIRCHEARTFAILURE.110.957829. - DOI - PMC - PubMed
    1. Cohen O, De La Zerda D, Beygui RE, Hekmat D, Laks H. Ethnicity as a predictor of graft longevity and recipient mortality in heart transplantation. Transplant Proc. 2007;39:3297–3302. doi: 10.1016/j.transproceed.2007.06.086. - DOI - PubMed

Publication types

MeSH terms