Abstract 8426: Racial Differences in Heart Transplant Wait-List and Early Post-Transplant Mortality in the United States

Abstract

Background: Racial differences in long-term outcomes after heart transplant (HT) are well known. However, racial differences in outcomes among those listed for a HT in the United States (US) have not been characterized. We sought to assess racial and ethnic differences in risk factors and in risk of wait-list and early post-transplant mortality among patients (pts) listed for a HT in the US in the current era Methods and Results: We identified all pts ≥18 yrs of age listed for a primary HT in the US during July, 2006- June, 2009 in the Organ Procurement and Transplant Network database. Of 7361 pts analyzed, 69% were white, 20% black, 7% Hispanic and 3% were “other’. Black and Hispanic pts were younger than white pts and were more likely to have blood type O (black 48%, Hispanic 53%, white 42%), dilated cardiomyopathy (71%, 56%, 39%, respectively), pulmonary artery wedge pressure >20 mm Hg (55%, 54%, 47%, respectively), listing status 1A or 1B (68%, 63%, 53%, respectively) and public medical insurance (25%, 26%, 10%, respectively) (P<0.001 for all). Overall, 11.5% of white, 12.5% of black and 14.8% of Hispanic pts listed for a HT died on the wait-list or became too sick to transplant. In an analysis adjusted for age, diagnosis, listing status, pulmonary artery wedge pressure, support variables (inotropes, ventilator, mechanical support, implantable cardioverter defibrillator) and renal function, both black (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.99, 1.43) and Hispanic (HR 1.65, 95% CI 1.25, 2.05) pts were at higher risk of dying on the wait-list or becoming too sick to transplant compared to white pts (P=0.002). These risks remained unchanged after further adjustment for blood type and medical insurance. Compared to white HT recipients, post-transplant in-hospital mortality was higher in black recipients (Odds ratio [OR] 1.47, 95% CI 1.13, 1.91) but was not different in Hispanic recipients (OR 0.87, CI 0.57, 1.32). Conclusions: Black and Hispanic pts listed for a HT in the US appear to be at higher risk of dying on the wait-list or becoming too sick to transplant compared to white pts. Black pts also appear to be at higher risk of early post-transplant mortality. Understanding the mechanisms for these racial differences in outcomes requires further investigation.