Disparities in heart and lung transplantation

Tsuang, Wayne; Khedraki, Rola; Hsich, Eileen

doi:10.1097/mot.0000000000000916

Cited by 13 publications

(6 citation statements)

References 64 publications

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“…Many geopolitical factors influence outcomes leading up to and following heart transplantation [33 ▪ ,34,35]. States have variable outcomes of patients listed for heart transplantation in the US, with respect to waitlist mortality, transplant rate, and one-year graft survival, with much room for standardization [36 ▪ ].…”

Section: Resultsmentioning

confidence: 99%

Disparities in heart transplantation

Zhao¹,

Henn²,

Mokadam³

et al. 2022

Current Opinion in Organ Transplantation

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Purpose of reviewHeart transplantation remains the gold standard therapy for end stage heart failure, but barriers remain, preventing equitable access to and affecting outcomes following transplantation. The objective of this review is to summarize current and historical literature on the disparities that persist, and to highlight the gaps in evidence for further investigation.Recent findingsAlthough progress has been made to increase the rates of advanced heart failure therapies to racial/ethnic minority populations and those with lower socioeconomic status, differential access and outcomes remain. The disparities that persist are categorized by patient demographics, social influences, geopolitical factors, and provider bias.SummaryDisparities in heart transplantation exist, which span a wide spectrum. Healthcare professionals need to be cognizant of these disparities that patients face in terms of access to and outcomes for heart transplantation. Further research and system changes are needed to make heart transplantation a fairer option for patients of varying backgrounds with end stage heart failure.

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Section: Resultsmentioning

confidence: 99%

Disparities in heart transplantation

Zhao¹,

Henn²,

Mokadam³

et al. 2022

Current Opinion in Organ Transplantation

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“…Historically, racial disparities in isolated HT outcomes have been noted for Black recipients [1,[4][5][6][7][8][9][10]. Previous literature suggests multiple potential causes of this fnding.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Heart transplantation (HT) is a defnitive therapy for refractory heart failure, making it the gold-standard treatment for recipients with end-stage disease [1][2][3]. Minority recipients, and specifcally black recipients, have historically experienced higher mortality rates post-HT than white recipients [1,[4][5][6][7][8][9][10]. Prior research has demonstrated a center efect such that Black recipients are more likely to receive their HT care at worse performing centers, but this is likely not the only contributing factor to the mortality diference [6].…”

Section: Introductionmentioning

confidence: 99%

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Improvement in Racial Disparities in Heart Transplantation following the Heart Allocation Policy Change

Sherard

Skidmore

Shorbaji

et al. 2023

Journal of Cardiac Surgery

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Objectives. Heart transplantation (HT) is a definitive therapy for refractory heart failure, making it the gold-standard treatment for recipients with end-stage disease. Heart allocation policy (HAP) in the United States was changed on October 18th, 2018. The aim of this study was to assess the effect of the new policy on racial disparities in heart transplantation (HT) outcomes. Methods. The United Network for Organ Sharing (UNOS) registry was used to identify adult recipients undergoing isolated HT between 2010 and 2021. Recipients were stratified into pre-HAP (January 2010 to September 2018) vs. post-HAP (October 2018 to September 2021). Recipient race was classified as White, Black, Hispanic, or other. The primary outcome was post-HT mortality. Cox proportional hazard models were used for risk-adjustment in evaluating the independent effect of race on post-HT mortality. Results. A total of 27,403 recipients underwent HT in 143 centers during study period. The proportion of non-Whites undergoing HT increased in the post-HAP era: (pre-HAP: White 66.0%, Black 21.2%, Hispanic 8.2%, Other 4.6% versus post-HAP: White 62.5%, Black 23.2%, Hispanic 9.5%, Other 4.8%; p < 0.001 ). In risk-adjusted analysis, Black recipients were at higher risk of post-HT mortality in the pre-HAP era (HR 1.31, 95% CI 1.22–1.41; p < 0.001 ) but not in the post-HAP era (HR 1.12, 95% CI 0.03–1.34; p = 0.222 ) compared to White recipients. Other non-White recipients had comparable risk-adjusted post-HT mortality rates compared to White recipients both in the pre-HAP and post-HAP eras. Conclusions. Under the new heart allocation system, a higher percentage of recipients are non-White. In addition, racial disparities in HT outcomes have improved with Black recipients no longer having an increased risk-adjusted mortality following HT.

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“…Multiple factors influence outcomes in thoracic organ transplantation 8 . Patient-specific factors such as sex, race, age, and underlying disease, have all been demonstrated to have an impact on transplant outcomes 9,10 . Further, geographic differences have also been seen in time on the waitlist, pre-transplant reliance on mechanical circulatory support (MCS), and post-transplant survival in both adult and pediatric populations [11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

Association of Heart Transplant Volume with Presence of Lung Transplant Programs and Heart Transplant’s SRTR One-year Survival Rating

Rosen,

Ahmad,

Uphadyaya

et al. 2023

Thorac Cardiovasc Surg

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Background: Several factors affect heart (HTx) and lung (LTx) transplant program outcomes. Variability in institutional and community characteristics have been shown to influence survival. At present, currently, half of HTx centers in the United States do not possess a concomitant LTx program. This study sought to better understand the relationship of HTx with and without LTx programs. Methods: Nationwide transplant data were collected from the Scientific Registry of Transplant Recipients (SRTR) in August 2020. SRTR star rating ranges from tier 1 (lowest) to tier 5 (highest). HTx volumes and SRTR star ratings for survival were compared between the centers with heart-only (H0) programs and the centers with heart-lung (HL) programs. Results: SRTR star ratings were available for 117 Transplant centers with one or more HTx reported. The median number of HTx performed over one year was 16 (IQR: 2-29). Number of HL centers (n=67, 57.3%) were comparable to H0 centers (n=50, 42.7%) (p= 0.14). The HTx volume at HL centers [28 (IQR: 17-41)] exceeded HTx volume at H0 centers [13 (IQR: 9-23)], (p <0.01); but were comparable to the LTx volume at HL centers [31 (IQR: 16-46)] (p=0.25). Median HTx 1- year survival rating was 3 (IQR: 2-4) at both H0 and HL centers (p= 0.85). HTx volume and LTx volume were positively associated with respective one-year survival (p< 0.01). Conclusion: While LTx program presence is not directly associated with HTx survival, it has positive association with HTx volume. HTx and LTx volumes are positively associated with one-year survival.

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Disparities in heart and lung transplantation

Cited by 13 publications

References 64 publications

Disparities in heart transplantation

Disparities in heart transplantation

Improvement in Racial Disparities in Heart Transplantation following the Heart Allocation Policy Change

Association of Heart Transplant Volume with Presence of Lung Transplant Programs and Heart Transplant’s SRTR One-year Survival Rating

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