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Better Understanding the Disparity Associated With Black Race in Heart Transplant Outcomes: A National Registry
Hasina Maredia1, Mary Grace Bowring1, Allan B Massie1,2
1Department of Surgery (H.M., M.G.B., A.B.M., S.B., A.K., S.O., R.S.D.H., D.L.S., E.L.B.), Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Young Black heart transplant recipients face a significantly higher mortality risk within the first year post-transplant. Addressing this disparity requires focused interventions for this vulnerable young population.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Disparities Research
Background:
- Racial disparities in heart transplant outcomes persist, with Black recipients experiencing higher mortality rates than White recipients.
- Understanding specific subgroups and high-risk periods is crucial for improving care for Black heart transplant recipients.
- Socioeconomic factors may disproportionately affect younger Black recipients, potentially increasing their early post-transplant mortality risk.
Purpose of the Study:
- To investigate the racial disparity in heart transplant mortality risk, focusing on age-related differences and the timing of mortality.
- To identify if the disparity is more pronounced in younger adult heart transplant recipients.
- To inform targeted interventions by elucidating specific risk periods for Black heart transplant recipients.
Main Methods:
- Analysis of 22,997 adult heart transplant recipients from the Scientific Registry of Transplant Recipients (2005-2017).
- Utilized Cox regression models adjusted for recipient, donor, and transplant characteristics.
- Examined mortality risk across different age groups (18-30, 31-40, 41-60, 61-80 years).
Main Results:
- Younger Black recipients (18-30 years) had a 2.05-fold higher mortality risk compared to non-Black recipients, primarily within the first year post-transplant.
- The increased mortality risk for Black recipients was attenuated in older age groups (31-60 years) and not significant in the oldest group (61-80 years).
- The heightened risk in young Black recipients was concentrated in the first year, with no significant difference after the first year.
Conclusions:
- Young Black heart transplant recipients face a substantial, previously masked, mortality risk in the first year after transplantation.
- Aggregate research on racial disparities has obscured the critical early-stage risk for this specific demographic.
- Future clinical research should prioritize targeted interventions for young Black recipients during the initial post-transplant year to reduce overall racial disparities.
Background:
Black heart transplant recipients have higher risk of mortality than White recipients. Better understanding of this disparity, including subgroups most affected and timing of the highest risk, is necessary to improve care of Black recipients. We hypothesize that this disparity may be most pronounced among young recipients, as barriers to care like socioeconomic factors may be particularly salient in a younger population and lead to higher early risk of mortality.
Methods:
We studied 22 997 adult heart transplant recipients using the Scientific Registry of Transplant Recipients data from January 2005 to 2017 using Cox regression models adjusted for recipient, donor, and transplant characteristics.
Results:
Among recipients aged 18 to 30 years, Black recipients had 2.05-fold (95% CI, 1.67-2.51) higher risk of mortality compared with non-Black recipients (P<0.001, interaction P<0.001); however, the risk was significant only in the first year post-transplant (first year: adjusted hazard ratio, 2.30 [95% CI, 1.60-3.31], P<0.001; after first year: adjusted hazard ratio, 0.84 [95% CI, 0.54-1.29]; P=0.4). This association was attenuated among recipients aged 31 to 40 and 41 to 60 years, in whom Black recipients had 1.53-fold ([95% CI, 1.25-1.89] P<0.001) and 1.20-fold ([95% CI, 1.09-1.33] P<0.001) higher risk of mortality. Among recipients aged 61 to 80 years, no significant association was seen with Black race (adjusted hazard ratio, 1.12 [95% CI, 0.97-1.29]; P=0.1).
Conclusions:
Young Black recipients have a high risk of mortality in the first year after heart transplant, which has been masked in decades of research looking at disparities in aggregate. To reduce overall racial disparities, clinical research moving forward should focus on targeted interventions for young Black recipients during this period.
