Abstract WP172: Racial Disparities In Perioperative Stroke And Mortality Following Stroke Among Pediatric Cardiac Transplant Recipients

Abstract

Introduction: In the general population, Black children have a higher incidence of stroke and all-cause mortality after stroke. Following cardiac transplantation, mortality is similar across Black and white children within the first 6 months, but Black children have higher mortality beyond 6 months. However, whether there are racial disparities in incidence and all-cause mortality following perioperative stroke among pediatric cardiac transplant recipients is unknown. Methods: Using the Scientific Registry of Transplant Recipients, we examined all children in the United States with their first heart transplant from January 1994-September 2019. We used multivariable logistic regression to assess the association between race and perioperative stroke. We used Kaplan Meier survival curves and multivariable piecewise Cox proportional hazard regression to examine the association between race and mortality among children who survived a perioperative stroke. Results: Among 8,224 children who had a first cardiac transplant, 255 (3%) had a perioperative stroke. Black children had a 32% lower odds of perioperative stroke compared to white children (OR=0.68, 95%CI 0.46-0.996). In unadjusted and multivariable-adjusted analyses, survival was similar for Black and white children in the first 6 months following perioperative stroke (Figure 1a, adjusted HR = 1.13, 95%CI 0.57-1.83), however Black children had a lower survival probability compared to white children beyond 6 months (Figure 1b, adjusted HR = 3.21, 95%CI 1.19-8.69, log-rank p=0.017). Conclusion: Among pediatric cardiac transplant recipients, Black children have a lower incidence of perioperative stroke than white children. Following perioperative stroke during cardiac transplantation, mortality is similar by race, but beyond 6 months, Black children have a higher mortality rate than white children. Intervening on potential differences in care is essential to addressing these disparities.