Racial Disparities in Heart Transplantation: Long-Term Graft Survival and Nonmortality Outcomes.

Background: Prior studies have reported conflicting evidence on racial disparities in heart transplant outcomes, often focusing only on short-term mortality rates. We assessed longer-term survival and a broader range of post-heart transplant outcomes by race.

Methods: We analyzed adult heart transplant recipients from 2017 to 2022 in the SRTR (Scientific Registry for Transplant Recipients), categorizing race as Black, non-Hispanic White, or Other. The primary outcome was graft failure at 1 and 3 years. Secondary outcomes included acute rejection, renal dysfunction, and posttransplant diabetes. χ² tests and Kaplan-Meier/logistic regression analyses were used.

Results: Among 15 873 recipients (63% White, 23% Black, 14% Other), Black recipients were more likely female, publicly insured, and less likely to be college educated. They also had higher use of durable ventricular assist devices and intra-aortic balloon pump at transplant. One-year graft survival was similar across groups (91.8% Black versus 91.1% non-Black), but 3-year survival was lower among Black individuals (83.4% versus 85.7%, P=0.006). After adjusting for socioeconomic and clinical factors, Black recipients had a higher risk of graft failure at 3 years (odds ratio, 1.22 [95% CI, 1.07-1.39]). Black patients also experienced higher rates of acute rejection (12.4% versus 10.2%), diabetes (10.8% versus 7.1%), and renal dysfunction progression (40.9% versus 37.1%) at 3 years (P<0.05 for all).

Conclusions: Racial disparities in heart transplant outcomes persist, particularly in longer-term survival. These disparities may be partially mediated by differences in posttransplant complications such as rejection, renal dysfunction, and diabetes.