Regional disparities in heart transplant mortality in the USA.

Background: Mortality after heart transplantation can be influenced by multiple factors. This study analysed its variation across four regions of the USA.

Objective: Analyse the differences in mortality among patients receiving a heart transplant across four regions of the USA.

Methods and results: Organ Procurement and Transplantation Network/United Network for Organ Sharing registry was analysed for adult heart transplant recipients from 1987 to 2023. They were divided into four regions according to heart transplant recipients' residence: the Northeast, Midwest, South, and West. The endpoint was all-cause mortality. 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), and 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 {hazard ratio (HR) 1.13 [95% confidence interval (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 USA. 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.