Racial Disparities in Survival After Lung Transplantation

Liu, Vincent; Weill, David; Bhattacharya, Jay

doi:10.1001/archsurg.2011.4

Cited by 33 publications

(16 citation statements)

References 37 publications

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“…This disparity contrasts with outcomes among recipients of lung transplantation, in whom the increased risk of death prior to 2001 among non-whites has been eliminated because mortality among non-white lung transplant recipients fell faster than that among white recipients 31 . This improved survival among non-white lung transplant recipients may have resulted from changes in immunosuppressive therapy—specifically, the decreased use of cyclosporine and the increased use of tacrolimus.…”

Section: Discussionmentioning

confidence: 90%

“…Our study cannot distinguish between biologic or socioeconomic factors as the primary reason for lower rates of effective immunosuppression among black recipients. It is notable that previous research suggests that barriers to appropriate cardiovascular care exist for both black and Hispanic patients with heart disease, and that these limitations in access to care may adversely affect mortality 1, 7, 37-41 . Interestingly, Hispanic transplant recipients in this study had lower rates of college education, U.S. citizenship, and private insurance than black recipients.…”

Section: Discussionmentioning

confidence: 99%

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Persistent Racial Disparities in Survival After Heart Transplantation

et al. 2011

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Background Racial and ethnic disparities are well-documented in many areas of health care but have not been comprehensively evaluated among recipients of heart transplantation. Methods and results We performed a retrospective cohort study of 39,075 adult primary heart transplant recipients from 1987-2009 using national data from the United Network of Organ Sharing, and compared mortality for non-white and white patients using the Cox proportional hazards model. During the study period, 8,082 non-white and 30,993 white patients underwent heart transplantation. Non-white heart transplant recipients increased over time, comprising nearly 30% of transplants since 2005. Non-white recipients had a higher clinical risk profile than white recipients at the time of transplantation but had significantly higher post-transplant mortality even after adjustment for baseline risk. Among the non-white group, only black recipients had an increased risk of death when compared with white recipients after multivariable adjustment for recipient, transplant, and socioeconomic factors (hazard ratio [HR] 1.34; 95% confidence interval [CI], 1.21-1.47; p<0.001). Five-year mortality was 35.7% (CI, 35.2%-38.3%) among black and 26.5% (CI, 26.0%-27.0%) among white recipients. Black patients were more likely to die from graft failure or a cardiovascular cause than white patients, but less likely to die from infection or malignancy. Although mortality decreased over time for all transplant recipients, the disparity in mortality between blacks and whites remained essentially unchanged. Conclusions Black heart transplant recipients have had persistently higher mortality than whites recipients over the past two decades, perhaps due to a higher rate of graft failure.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Persistent Racial Disparities in Survival After Heart Transplantation

et al. 2011

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“…Unlike prior studies, we chose to include all diagnostic groups in order to maximize study power and assess the overall effect of the LAS on disparities in lung transplantation. More recently, Liu et al found that, when compared to the historical transplant era (1987–2000), there was no significant difference in lung transplant survival between whites and nonwhites in the modern era (2001–2009); however, the effect of the LAS was not specifically examined, and all racial groups not classified as white were included in the nonwhite category 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Studies evaluating the LAS suggest that waiting time has decreased, the total number of organs transplanted has increased, waitlist mortality has decreased, and post-transplant survival is unchanged 13–17 . A recent study also found no difference in survival after lung transplantation between whites and non-whites from 2001–2009 18 . However, it is unclear whether ethnic disparities identified in waitlisted patients before the LAS system was adopted have subsequently improved.…”

Section: Introductionmentioning

confidence: 90%

Disparities in lung transplantation before and after introduction of the lung allocation score

Wille

Harrington

deAndrade

et al. 2013

The Journal of Heart and Lung Transplantation

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Background In May 2005 the lung allocation score (LAS) became the primary method for determining allocation of lungs for organ transplantation for those at least 12 years of age in the United States. During the pre-LAS period, black patients were more likely than white patients to become too sick or die while awaiting transplant. The association between gender and lung transplant outcomes has not been widely studied. Methods Black and white patients ≥18 years of age registered on the UNOS lung transplantation waiting list from January 1, 2000-May 3, 2005 (pre-LAS, n=8765) and May 4, 2005-September 13, 2010 (LAS, n=8806) were included; logistic regression analyses were based on smaller cohorts derived from patients listed in the first 2 years of each era (pre-LAS, n=2350, and LAS, n=2446) to allow for follow-up time. Lung transplantation was the primary outcome measure. Multivariable analyses were performed within each time period to determine the odds of dying or receiving a lung transplant within three years of listing. Results In the pre-LAS era, black patients were more likely than white to become too sick for transplantation or die within three years of wait list registration (43.8% vs. 30.8%; odds ratio [OR] 1.84; p<0.001). Race was not associated with death or becoming too sick while listed for transplantation in the LAS era (14.0% vs. 13.3%; OR 0.93; p=0.74). Black patients were less likely to undergo transplantation in the pre-LAS era (56.3% vs. 69.2%; OR 0.54; p<0.001) but not in the LAS era (86.0% vs. 86.7%; OR 1.07; p=0.74). Women were more likely than men to die or become too sick for transplantation within three years of listing in the LAS era (16.1% vs. 11.3%; OR 1.58; p<0.001), as compared to the pre-LAS era (33.4% vs. 30.7%; OR 1.19; p=0.08). Conclusion Racial disparities in lung transplantation have decreased with the implementation of LAS as the method of organ allocation; however, gender disparities may have actually increased in the LAS era.

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“…[2][3][4] However, on further consideration, the article highlights a more overarching contemporary issue in medicine that requires critical attention. That issue is how we conceptualize and, importantly, use language to describe variation among population groups.…”

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confidence: 99%

Racial Differences and Racial Disparities

Taylor

2015

Circulation

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Racial Disparities in Survival After Lung Transplantation

Cited by 33 publications

References 37 publications

Persistent Racial Disparities in Survival After Heart Transplantation

Persistent Racial Disparities in Survival After Heart Transplantation

Disparities in lung transplantation before and after introduction of the lung allocation score

Racial Differences and Racial Disparities

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