Disparities in heart transplant survival and graft rejection outcomes persist in the modern era: a call to race towards a more equitable future.

Abstract

Objectives: Racial and ethnic disparities remain an ongoing challenge in healthcare. Such inequities have been reported in heart transplantation (HTx); however, there is limited data within the modern era. Additionally, there is scarce information on outcomes besides death, such as graft rejection. Therefore, our investigation aims to add further data on contemporary racial and ethnic disparities on post-transplant outcomes.

Methods: Adult isolated HTx recipients who were transplanted between 1/2000 and 9/2023 were analysed using the United Network for Organ Sharing (UNOS) database. Inclusion criteria included 'White', 'Black', 'Hispanic' and 'Asian' recipients. Two primary outcomes of interest were analysed: mortality and cardiac allograft vasculopathy (CAV). Survival was assessed using a cause-specific model, whereas CAV analysis utilized a competing-risk approach. Subgroup survival analysis was conducted for patients listed in the years prior to (11/2013-10/2018) and after (10/2018-9/2023) the 2018 heart allocation policy (HAP) changes.

Results: A total of 50 243 patients were included in our analysis. Black recipients were the only group found to have an increased overall (hazard ratio [HR] = 1.30, P < 0.001) and post-HAP (HR = 1.36, P < 0.001) mortality risk. Asian (HR = 1.19, P= 0.001) and Hispanic (HR = 1.15, P < 0.001) recipients had elevated risks of CAV, whereas Black patients had similar risk (HR = 1.00, P = 0.864) as White recipients.

Conclusions: Our investigation suggests that disparities continue to exist for minority groups after HTx. Notably, the 2018 allocation changes may have introduced or exacerbated such inequities for Black recipients.