Regional disparities in heart transplant mortality in the USA

Abstract

Background Mortality after heart transplantation can be influenced by multiple factors. This study analyzed its variation across 4 regions of the United States. Objective Analyze the differences in mortality among patients receiving a heart transplant across 4 regions of the United States. Methods Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) registry was analyzed for adult heart transplant recipients from 1987-2023. They were divided into 4 regions according to heart transplant recipients’ residence: the Northeast, Midwest, South, and West. The endpoint was all-cause mortality. Results A total of 33,482 heart transplant recipients were included in the analysis. Baseline characteristics differed by region. The median survival (years) was lower in the South [Northeast 12.9 (6.1-17.9), Midwest 13.1 (6.5-18.1), South 11.6 (5.3-16.8), West 13.6 (7.0-18.6); p<0.0001]. Mortality incidence rate was greater in the South. When compared to the Northeast, in the unadjusted analysis, mortality was higher in the South [HR 1.13 (95%CI 1.07-1.19), p<0.001] and lower in the West [HR 0.89 (95%CI 0.83-0.94), p<0.001]. After adjusting for demographic and clinical variables, only the South retained significant differences [HR 1.17 (95%CI 1.10-1.24), p<0.001]. Mortality significantly increased in all regions after 2018. Conclusion Mortality of heart transplant recipients varies across region of residence in the United States. A significant increase in adjusted mortality was observed in the South. These findings suggest that there are regional disparities in the mortality rates of heart transplant recipients.