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Cardiac transplantation in African Americans: a single-center experience
Prakash Goutham Suryanarayana1, Hannah Copeland, Mark Friedman
1Department of Cardiology Sarver Heart Center, University of Arizona Medical Center, Tucson, Arizona.
Insights
African American heart transplant recipients have significantly lower survival rates compared to non-African American recipients. Key factors influencing outcomes include ethnicity and pre-transplant creatinine levels.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Disparities
Background:
- Limited data exists on survival differences between African American (AA) and non-AA heart transplant recipients.
- Existing research suggests potential disparities in cardiac transplantation outcomes.
Purpose of the Study:
- To investigate and compare graft and patient survival rates between AA and non-AA heart transplant recipients.
- To identify factors influencing outcomes in these distinct patient groups.
Main Methods:
- Retrospective review of all AA heart transplant recipients since 1983.
- Utilized stepwise Cox regression and Kaplan-Meier curves to analyze survival data.
- Chi-squared test assessed the impact of mechanical assist devices and pre-transplant creatinine (Cr) levels.
Main Results:
- AA recipients had significantly lower 1-, 5-, and 10-year survival rates (80%, 55%, 25%) compared to non-AA recipients (92%, 78%, 58%).
- Ethnicity, pre-transplant Cr, mechanical assist device use, and UNOS status independently predicted outcomes.
- AA patients showed worse survival across all pre-transplant Cr classes.
Conclusions:
- Significant outcome disparities exist between AA and non-AA heart transplant recipients.
- AA patients experience decreased long-term survival post-cardiac transplantation.
- Pre-transplant Cr, ethnicity, mechanical assist device, and UNOS status are independent predictors of cardiac transplant outcomes.
Background:
In view of limited data on the subject of graft and patient survival differences between African American (AA) and non-AA heart transplant recipients, we reviewed our experience.
Hypothesis:
There is a higher mortality among AA recipients compared with non-AA recipients after cardiac transplantation.
Methods:
The study included all AA patients who have received a heart transplant in our center since 1983. Stepwise Cox regression was used for covariates affecting the survival. The χ(2) test was employed to identify the effects of a mechanical assist device and pretransplant creatinine (Cr) on the outcomes in AA and non-AA patients. Kaplan-Meier curves were used to examine survival.
Results:
The average survival among AA recipients was 5.4 years, compared with 12 years for the non-AA recipients, with 1-, 5-, and 10-year survival rates of 80%, 55%, and 25%, respectively. This was found to be statistically inferior to the survival probabilities of 92%, 78%, and 58% for the non-AA group (P < 0.005). Based on stepwise Cox regression, the variables such as ethnicity (P < 0.05), pretransplant Cr (P < 0.05), presence of a mechanical assist device (P < 0.005), and United Network for Organ Sharing (UNOS) status at transplant (P < 0.05) independently predicted the outcomes. Kaplan-Meier analysis of pretransplant Cr level and survival showed that the AA group did significantly worse for all Cr classes.
Conclusions:
There is a statistically significant difference in outcomes between AA and non-AA patients after cardiac transplantation. African American patients have decreased survival over a period of time. Pretransplant Cr, ethnicity, presence of a mechanical assist device, and UNOS status at transplantation are independent predictors of outcomes.
