Improvement in Racial Disparities in Heart Transplantation following the Heart Allocation Policy Change

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2023-03-31 DOI:10.1155/2023/5061721

Curry Sherard, Savannah Skidmore, K. Shorbaji, B. Welch, K. Bhandari, A. Kilic

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引用次数: 0

Abstract

Objectives. Heart transplantation (HT) is a definitive therapy for refractory heart failure, making it the gold-standard treatment for recipients with end-stage disease. Heart allocation policy (HAP) in the United States was changed on October 18th, 2018. The aim of this study was to assess the effect of the new policy on racial disparities in heart transplantation (HT) outcomes. Methods. The United Network for Organ Sharing (UNOS) registry was used to identify adult recipients undergoing isolated HT between 2010 and 2021. Recipients were stratified into pre-HAP (January 2010 to September 2018) vs. post-HAP (October 2018 to September 2021). Recipient race was classified as White, Black, Hispanic, or other. The primary outcome was post-HT mortality. Cox proportional hazard models were used for risk-adjustment in evaluating the independent effect of race on post-HT mortality. Results. A total of 27,403 recipients underwent HT in 143 centers during study period. The proportion of non-Whites undergoing HT increased in the post-HAP era: (pre-HAP: White 66.0%, Black 21.2%, Hispanic 8.2%, Other 4.6% versus post-HAP: White 62.5%, Black 23.2%, Hispanic 9.5%, Other 4.8%; p < 0.001 ). In risk-adjusted analysis, Black recipients were at higher risk of post-HT mortality in the pre-HAP era (HR 1.31, 95% CI 1.22–1.41; p < 0.001 ) but not in the post-HAP era (HR 1.12, 95% CI 0.03–1.34; p = 0.222 ) compared to White recipients. Other non-White recipients had comparable risk-adjusted post-HT mortality rates compared to White recipients both in the pre-HAP and post-HAP eras. Conclusions. Under the new heart allocation system, a higher percentage of recipients are non-White. In addition, racial disparities in HT outcomes have improved with Black recipients no longer having an increased risk-adjusted mortality following HT.

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心脏分配政策改变后心脏移植中种族差异的改善

目标。心脏移植（HT）是治疗难治性心力衰竭的最终疗法，是治疗终末期疾病的金标准。2018年10月18日，美国心脏分配政策（HAP）发生了变化。本研究的目的是评估新政策对心脏移植（HT）结果种族差异的影响。方法。器官共享联合网络（UNOS）登记用于识别2010年至2021年间接受隔离HT的成年接受者。受试者被分为HAP前（2010年1月至2018年9月）和HAP后（2018年10月至2021年九月）。接受者种族分为白人、黑人、西班牙裔或其他种族。主要结果是HT后死亡率。Cox比例风险模型用于风险调整，以评估种族对HT后死亡率的独立影响。后果在研究期间，143个中心共有27403名受试者接受了HT治疗。在后HAP时代，接受HT的非白人比例增加：（HAP前：白人66.0%，黑人21.2%，西班牙裔8.2%，其他4.6%，而HAP后：白人62.5%，黑人23.2%，西班牙裔9.5%，其他4.8%；p<0.001）。在风险调整分析中，与白人受试者相比，黑人受试者在HAP前时期HT后死亡的风险更高（HR 1.31，95%CI 1.22-1.41；p<0.001），但在HAP后时期没有（HR 1.12，95%CI 0.03-1.34；p=0.222）。在HAP前和HAP后时期，与白人受试者相比，其他非白人受试人在HT后的风险调整死亡率相当。结论。在新的心脏分配系统下，非白人接受者的比例更高。此外，HT结果的种族差异有所改善，黑人接受者在HT后的风险调整死亡率不再增加。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.