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
. 2021 Sep 7;10(17):e021067.
doi: 10.1161/JAHA.120.021067. Epub 2021 Aug 25.

Evaluation of Racial and Ethnic Disparities in Cardiac Transplantation

Fouad Chouairi  1 , Michael Fuery  2 , Katherine A Clark  1 , Clancy W Mullan  3 , James Stewart  3 , Cesar Caraballo  1 , John-Ross D Clarke  1 , Sounok Sen  1 , Avirup Guha  4 , Nasrien E Ibrahim  5 , Robert T Cole  6 , Louisa Holaday  2   7 , Muhammed Anwer  3 , Arnar Geirsson  3 , Joseph G Rogers  8 , Eric J Velazquez  1 , Nihar R Desai  1 , Tariq Ahmad  1 , P Elliott Miller  1   7
Affiliations

Evaluation of Racial and Ethnic Disparities in Cardiac Transplantation

Fouad Chouairi et al. J Am Heart Assoc. .

Abstract

Background Racial and ethnic disparities contribute to differences in access and outcomes for patients undergoing heart transplantation. We evaluated contemporary outcomes for heart transplantation stratified by race and ethnicity as well as the new 2018 allocation system. Methods and Results Adult heart recipients from 2011 to 2020 were identified in the United Network for Organ Sharing database and stratified into 3 groups: Black, Hispanic, and White. We analyzed recipient and donor characteristics, and outcomes. Among 32 353 patients (25% Black, 9% Hispanic, 66% White), Black and Hispanic patients were younger, more likely to be women and have diabetes mellitus or renal disease (all, P<0.05). Over the study period, the proportion of Black and Hispanic patients listed for transplant increased: 21.7% to 28.2% (P=0.003) and 7.7% to 9.0% (P=0.002), respectively. Compared with White patients, Black patients were less likely to undergo transplantation (adjusted hazard ratio [aHR], 0.87; CI, 0.84-0.90; P<0.001), but had a higher risk of post-transplant death (aHR, 1.14; CI, 1.04-1.24; P=0.004). There were no differences in transplantation likelihood or post-transplant mortality between Hispanic and White patients. Following the allocation system change, transplantation rates increased for all groups (P<0.05). However, Black patients still had a lower likelihood of transplantation than White patients (aHR, 0.90; CI, 0.79-0.99; P=0.024). Conclusions Although the proportion of Black and Hispanic patients listed for cardiac transplantation have increased, significant disparities remain. Compared with White patients, Black patients were less likely to be transplanted, even with the new allocation system, and had a higher risk of post-transplantation death.

Keywords: disparities; heart failure; heart transplantation; race and ethnicity.

PubMed Disclaimer

Conflict of interest statement

Dr Desai works under contract with the Centers for Medicare and Medicaid Services to develop and maintain performance measures used for public reporting and pay for performance programs. He reports research grants and consulting for Amgen, Astra Zeneca, Boehringer Ingelheim, Cytokinetics, Medicines Company, Relypsa, Novartis, and SCPharmaceuticals. Dr Ahmad is a consultant for Amgen, Cytokinetics, Relypsa, and Novartis. The other authors have no disclosures.

Figures

Figure 1
Figure 1. Race and ethnicity of patients listed over time: proportion of patients listed for transplantation by race and ethnicity from 2011 to 2020.
Trends were analyzed with linear regression. Linear regression: P<0.001, all.
Figure 2
Figure 2. Race and ethnicity of patients transplanted over time: proportions of patients transplanted by race and ethnicity from 2011 to 2020.
Trends were analyzed with linear regression. Linear regression: Black: P=0.003, Hispanic: P=0.002, White: P<0.001.
See this image and copyright information in PMC

Comment in

References

    1. Liu V, Bhattacharya J, Weill D, Hlatky MA. Persistent racial disparities in survival after heart transplantation. Circulation. 2011;123:1642–1649. DOI: 10.1161/CIRCULATIONAHA.110.976811. - DOI - PMC - 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. Circ Heart Fail. 2011;4:153–160. DOI: 10.1161/CIRCHEARTFAILURE.110.957829. - DOI - PMC - PubMed
    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. Ann Thorac Surg. 2010;89:1956–1964; discussion 1963–1964. DOI: 10.1016/j.athoracsur.2010.02.093. - DOI - PubMed
    1. Kilic A, Higgins RS, Whitson BA, Kilic A. Racial disparities in outcomes of adult heart transplantation. Circulation. 2015;131:882–889. DOI: 10.1161/CIRCULATIONAHA.114.011676. - DOI - PubMed
    1. Morris AA, Kransdorf EP, Coleman BL, Colvin M. Racial and ethnic disparities in outcomes after heart transplantation: a systematic review of contributing factors and future directions to close the outcomes gap. J Heart Lung Transplant. 2016;35:953–961. DOI: 10.1016/j.healun.2016.01.1231. - DOI - PMC - PubMed

Publication types