Despite improvements in transplant procedures over the past 2 decades, a new study finds that survival disparities still exist between black and white patients undergoing heart transplants. A group of Stanford University researchers analyzed national outcomes data for 39,075 patients who underwent heart transplants over a 22-year period. The 4,997 black patients had a 34 percent higher risk of transplant-related death than the 30,993 whites, after adjustment for recipient, transplantation, and socioeconomic factors.
Other nonblack minority transplant recipients (2,118 Hispanics, 967 Asians, and patients from other nonblack racial groups) did not differ from whites in adjusted risk of death. Overall, 16,880 patients died after transplantation during the period covered by the data. The rate of second transplants was similar for all of the groups (from 2-2.5 percent).
Blacks were more likely to die of graft failure or a cardiovascular problem than were whites or other nonwhites (57.9 percent, 37.8 percent, and 44.1 percent, respectively), but less likely to die from an infection or cancer (19.9 percent for blacks, 33.0 percent for whites, and 28.2 percent for other nonwhites). Rates of hospitalization for graft rejection and noncompliance with a regimen of immunosuppressive drugs were higher for blacks than for whites or other minority groups. According to the researchers, the patterns in causes of death suggest that black patients experienced inadequate immunosuppression.
The findings were based on data from the United Network on Organ Sharing on adult patients who underwent heart transplant surgery between October 1987 and February 2009. The study was funded in part by the Agency for Healthcare Research and Quality (HS19181).
More details are in "Persistent racial disparities in survival after heart transplantation," by Vincent Liu, M.D., M.S., Jay Bhattacharaya, M.D., Ph.D., David Weill, M.D., and others in the April 19, 2011, Circulation 123(15), pp. 1642-1649.