Adult Heart Transplant Survival in the United States: Regional and Racial Disparities From 2002 to 2022

This study investigated racial disparities in mortality after heart transplantation across 4 regions of the United States: Northeast, Midwest, South, and West.

The United Network for Organ Sharing registry was evaluated for all adult heart transplant recipients (HTr) from 2002 to 2022. HTr were grouped by US regional residency and by 5 self-identified race/ethnicity groups: White, Black, Hispanic, Asian, and Other. Kaplan-Meier and Cox proportional hazards regression model were used to assess mortality rates.

A total of 33 223 patients were analyzed. Mortality rates showed significant differences in regional disparities for White HTr ( P  = 0.002) at 6 mo, 1 y, and 5 y posttransplant and for Other recipients ( P  = 0.004) at 5 y posttransplant. When compared with the Northeast in the unadjusted analysis, White HTr had an increased mortality in the South (hazard ratio [HR], 1.12 [95% confidence interval [CI], 1.05-1.20]; P  < 0.001), and a decreased mortality risk in the West (HR, 0.85 [95% CI, 0.79-0.92]; P  < 0.001). However, when adjusted for covariables, there was only a significant decrease in mortality risk in the West (HR, 0.77 [95% CI, 0.69-0.86]; P  < 0.001).

There are significant differences in mortality risk among White HTr, with a higher mortality risk in the South and a lower mortality risk in the West in the unadjusted analysis. In the multivariate analysis, White HTr from the Western region had a lower mortality risk. No significant geographic differences were observed among Black, Hispanic, Asian, or Other recipients, suggesting that factors influencing posttransplant outcomes in these groups may be more consistent throughout the United States.