Racial disparities in cardiac transplantation: Chronological perspective and outcomes

Abstract

Background The objective of this study was to evaluate annual heart transplant volumes and 3-year post-transplant outcomes since establishment of United Network for Organ Sharing (UNOS) database stratified by race. Methods The UNOS thoracic transplant database was evaluated for adult patients since 1987. The available database was then stratified by Race: Black, White and Other and era of transplant: group 1(1987–1991), group 2(1992–1996), group 3(1997–2001), group 4(2002–2006), group 5(2007–2011), group 6(2012–2016) and group 7(2017 and later). Demographic and clinical factors were evaluated. Results A total of 105,266 adults have been listed since 1987 and 67,824 have been transplanted. Of the transplanted patients 11,235 were Black, 48,786 White and 6803 were of Other race. The proportion of Black patients listed increased from 7% in 1987 to 13.4% in 1999 and 25% in 2019 and those transplanted increased from 5% in 1987 to 13.4% in 2001 and 26% in 2019. The survival of Black patients gradually improved. Conclusion Historically, fewer Black patients received cardiac transplantation however, their access gradually improved over the years and account for over 25% of cardiac transplantations performed in recent years. The historically poor survival of Black patients has recently improved and became comparable to the rest.

Disparities in Social Determinants of Health Among Patients Receiving Liver Transplant: Analysis of the National Inpatient Sample From 2016 to 2019

“…Compared to White patients, Black and Native American patients were less likely to receive liver transplants while Asians and Hispanic patients were more likely to. Multiple studies have shown similar racial disparities in other organ transplantation fields such as bone marrow, renal, and heart transplantation [19][20][21][22][23][24][25]. Interestingly, Moylan et al previously demonstrated that race was not significantly associated with liver transplantation or death in the post-MELD era; however, they found that non-White patients were often listed at a more advanced stage of disease [14].…”

Racial disparities in post-transplant stroke and mortality following stroke in adult cardiac transplant recipients in the United States

“…Several single-center studies have suggested that advances in transplant recipient selection, care of patients awaiting a heart transplant, and post-transplant care of transplant recipients have contributed to early survival improvements following transplantation for both white and Black patients [ 22 – 24 ]. A recent study using the UNOS database found that the historically poor survival of adult Black heart transplant recipients has gradually improved and became comparable to that of white transplant recipients [ 25 ]. General improvement in care, better compliance with the immunosuppression, reliable insurance coverage and increased awareness about reducing racial disparities in recent years could be contributing factors in improved survival of Black patients [ 26 ].…”

Post-transplant mortality and graft failure after induction immunosuppression among Black heart transplant recipients in the United States

“…Black heart transplant recipients are historically reported to be at high risk of graft failure and all-cause mortality, 1,2,17 although a recent study by Trivedi et al reported improved post-transplant survival at 3-years in the most recent era. 18 They suggested that this improvement may be due to multiple factors including improved care, better compliance with immunosuppression, reliable insurance, and increased awareness about reducing racial disparities. Socioeconomic factors such as low levels of education and less insurance coverage have been highlighted as contributing to the worse outcomes in Black patients, but other biological factors have also been implicated.…”

“…Black heart transplant recipients are historically reported to be at high risk of graft failure and all‐cause mortality, 1,2,17 although a recent study by Trivedi et al reported improved post‐transplant survival at 3‐years in the most recent era 18 . They suggested that this improvement may be due to multiple factors including improved care, better compliance with immunosuppression, reliable insurance, and increased awareness about reducing racial disparities.…”