Abstract 9536: The Influence of Social Determinants of Health and Race on Pediatric Heart Transplant Outcomes

Abstract

Introduction: While traditional registry-based analyses have outlined that Black children have worse post-heart transplant (HT) outcomes, it is not entirely clear if such differences persist after accounting for social determinants of health (SDOH). Hypothesis: After accounting for SDOH, Black children from distressed communities will continue to have worse post-HT outcomes compared to White children. Methods: All children in the Pediatric Heart Transplant Society (PHTS) database that underwent HT in the U.S. from January 2010 - December 2020 were included. Recipient zip codes from PHTS and the Scientific Registry of Transplant Recipients databases were used to create a pediatric specific community risk score for each transplanted recipient. Lower risk communities (quartiles 1 and 2) were labelled prosperous and the higher risk (quartiles 3 and 4) as distressed communities. The effects of community risk and self-identified race on post-HT rejection, cardiac allograft vasculopathy (CAV) and graft loss were evaluated unadjusted and after adjusting for donor and recipient risk factors. Results: Of 3680 children transplanted, 1911 (51.9%) lived in prosperous and 1769 (48.1%) in distressed communities. Unadjusted analysis revealed that Black children from distressed communities had higher rejection (p=0.0013), CAV (p=0.0011) and graft loss (p<0.0001) (Figure) . In multivariable adjusted analysis, Black children from distressed communities experienced increased rejection (HR 1.33, 95%CI 1.03-1.71), CAV (HR 2.06, 95%CI 1.21-3.51) and graft loss (HR 1.66, 95%CI 1.12-2.46), while white children did not experience increased rejection (HR 0.99, 95%CI 0.86-1.14), CAV (HR 0.95, 95%CI 0.69-1.32) or graft loss (HR 1.17, 95%CI 0.92-1.48). Conclusions: This study found that SDOH independently affects post-HT outcomes for Black, but not White children. More studies will be necessary to identify the root causes to be able to address these racial disparities.