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. 2022 Jul 5;2(4):504-512.
doi: 10.1016/j.jacasi.2022.03.012. eCollection 2022 Aug.

Combined Heart-Lung Transplantation Outcomes in Asian Populations: National Database Analysis

Yasuhiro Shudo  1 , Matthew Leipzig  1 , Hao He  1 , Shreya Mukund Ingle  1   2   3 , Rishab Harish Bhatt  1   3   4 , Hye-Sook Shin  1 , Y Joseph Woo  1
Affiliations

Combined Heart-Lung Transplantation Outcomes in Asian Populations: National Database Analysis

Yasuhiro Shudo et al. JACC Asia. .

Abstract

Background: Heart-lung transplantation (HLTx) is a definitive surgical procedure for end-stage cardiopulmonary failure. Studies to understand the relationship between ethnicity and race and outcomes after HLTx are needed to uphold equitable HLTx access to the increasingly diverse U.S. population facing advanced cardiopulmonary failure.

Objectives: This study sought to examine the outcomes of HLTx recipients of Asian origin, with emphasis on the ethnic and racial disparities in the outcomes.

Methods: We analyzed data from the United Network for Organ Sharing (UNOS) for patients of ≥18 years of age who underwent HLTx between 1987 and 2021. Propensity-score matching was performed between Asian and non-Hispanic Whites (NHWs), with a 1:3 matching ratio based on the propensity score of each patient estimated by multivariable logistic regression.

Results: We identified 42 Asian and Asian American heart-lung transplant recipients and 834 NHW recipients. In the pre-matched cohort, the median survival was 1,459 days (IQR: 1,080-2,692 days) in Asian recipients after transplantation, whereas it was 1,521 days (IQR: 1,262-1,841 days) in White recipients. Of the 876 recipients, 156 transplants were successfully matched (Asian, n = 36; NHW, n = 108). Among the post-transplantation outcomes, there were no significant differences in morbidity and mortality between Asian and NHW cohorts.

Conclusions: This large-scale analysis in Asian patients will have important implications in Asian countries that have relatively fewer HLTx surgeries. An outcome equivalent to NHW in Asian patients, as demonstrated in our study, could be the driving force for further expansion of HLTx surgeries in Asian countries.

Keywords: Asian Americans; BMI, body mass index; ECMO, extracorporeal membrane oxygenation; HLTx, heart-lung transplantation; NHW, non-Hispanic White; UNOS, United Network for Organ Sharing; heart-lung transplantation; morbidity; propensity score.

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Conflict of interest statement

The Stanford Center for Asian Health Research and Education (CARE) and the CARE Scholars program has provided funding support of this project. The data reported in this study were supplied by the United Network for Organ Sharing as the contractor for the Organ Procurement and Transplantation Network. The United Network for Organ Sharing is a private non-profit organization that manages the nation’s organ transplant system under contract with the federal government. This system serves as a model for transplant systems worldwide. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Pre-Matched Kaplan-Meier Survival Analysis The survival probability of Asian heart-lung transplant recipients was significantly higher than that of non-Hispanic White (NHW) recipients at 1 year (P = 0.0093, log-rank test). Shaded area = 95% CI. + = censored.
Central Illustration
Central Illustration
Matched Kaplan-Meier Survival Analysis The survival probability of Asian heart-lung transplant recipients was similar to that of non-Hispanic White (NHW) recipients at 1 year (P = 0.18, log-rank test). Shaded area = 95% CI. + = censored.
Figure 2
Figure 2
Love Summary Plot Showing the Absolute Standardized Mean Differences Dotted vertical line at standardized mean differences 0.1 to indicate whether variables are balanced (<0.1) or not (>0.1).
See this image and copyright information in PMC

References

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