Do outcomes for heart transplantation differ based on donor and recipient race?

Area of Science:

• Cardiology
• Transplantation Medicine
• Health Disparities Research

Background:

• Limited data exist on how donor and recipient race influence outcomes after orthotopic heart transplantation (OHT).
• Understanding these racial dynamics is crucial for addressing potential disparities in heart transplant care.

Purpose of the Study:

• To evaluate the relationship between donor and recipient race and their impact on OHT outcomes.
• To identify if racial concordance or discordance affects patient survival and post-transplant rejection rates.

Main Methods:

• Retrospective review of the United Network for Organ Sharing (UNOS) database (January 2000 - March 2018).
• Analysis included 41,841 OHT cases, comparing outcomes based on donor and recipient race (White, Black, Hispanic).
• Statistical models (logistic and Cox) were used to assess 30-day and 1-year survival, and rejection rates.

Main Results:

• Hispanic recipients had decreased 30-day (OR 1.27) and 1-year (OR 1.17) survival compared to White recipients.
• Donor-recipient combinations involving African American recipients (regardless of donor race) showed decreased overall survival compared to White-White combinations.
• Black recipients were more likely to receive hearts with urgent status, while Hispanic recipients were more likely to receive non-urgent transplants.

Conclusions:

• African American and Hispanic recipients experience reduced survival post-heart transplant compared to White recipients.
• Donor race does not appear to negatively impact survival, but significant racial disparities persist in OHT.
• Expanding the donor pool across all races and ethnicities is recommended to potentially improve outcomes and reduce disparities.