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Published on: June 6, 2025
Black Race Is Associated With Improved Short-Term Survival After Heart Transplantation Under the Current Organ
Michael Zhu1, Charley Sun1, Patrick Warner2
1Tufts University School of Medicine, Boston, MA.
Insights
Black heart transplant recipients experienced lower short-term mortality after the 2018 UNOS policy change. However, this survival advantage diminished by one year, indicating persistent disparities in heart transplantation outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Disparities Research
Background:
- Racial disparities in heart transplantation outcomes have been a persistent concern.
- The 2018 United Network for Organ Sharing (UNOS) policy aimed to improve organ allocation equity.
- The impact of the new policy on racial disparities in heart transplant (HTX) mortality requires evaluation.
Purpose of the Study:
- To determine if racial disparities in mortality after heart transplantation persist following the implementation of the 2018 UNOS allocation policy.
- To compare outcomes between Black and White heart transplant recipients under the new policy.
Main Methods:
- Retrospective analysis of adult heart transplant recipients from the UNOS database (October 2018 - January 2023).
- Comparison of donor and recipient characteristics between Black and White recipients.
- Propensity score matching (PSM) to adjust for baseline differences and compare clinical outcomes.
Main Results:
- The study included 7325 White and 2865 Black recipients; 2862 matched pairs were analyzed.
- Black recipients showed significantly lower 30-day (1.8% vs 3.2%) and 180-day (5.6% vs 7.0%) mortality.
- One-year mortality rates were not significantly different (7.7% vs 8.7%), and Black race was associated with lower 30-day mortality risk (HR 0.73).
Conclusions:
- The new UNOS allocation policy is associated with lower short-term mortality for Black heart transplant recipients.
- The survival benefit observed in Black recipients appears to diminish over the first year post-transplant.
- Evolving patterns of racial disparities in heart transplantation necessitate further investigation.
Objective:
To investigate whether racial disparities in mortality after heart transplantation remain after introduction of the new United Network for Organ Sharing (UNOS) allocation policy in 2018.
Methods:
All adult heart transplant (HTX) recipients between October 2018 and January 2023 were identified from the UNOS database. Donor and recipient characteristics were compared between black and white recipients. Clinical outcomes also were compared between the 2 racial groups before and after propensity score matching (PSM).
Results:
A total of 7325 white and 2865 black recipients of isolated first-time HTX were included. PSM identified 2862 pairs of recipients. Black recipients had lower 30-day mortality (1.8% vs 3.2%; P = .001) and 180-day mortality (5.6% vs 7.0%; P = .043); however, 1-year mortality was not significantly different between black and white recipients (7.7% vs 8.7%; P = .164). Multivariate analysis revealed the black race was significantly associated with a lower risk of 30-day mortality (hazard ratio, 0.73; 95% confidence interval, 0.54-0.98; P = .037).
Conclusion:
Under the new allocation policy, black HTX recipients have lower short-term mortality; however, the survival benefit of black HTX recipients appears to dissipate over time. This new pattern of disparities in HTX warrants further investigation.
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