Gender and Racial Disparities in Pediatric Heart Transplantation in the Current Era: A UNOS Registry Analysis

Abstract

In adults, female (F) and African American (AA) heart transplant (HT) recipients have higher waitlist (WL) and post-transplant (PT) mortality. Our study aims to evaluate gender and racial disparities in pediatric recipients and its effect on survival in the WL and PT period in the current era. Pediatric (<18 years, n=3257) pts listed for HT from 2012-2017 were included. Clinical characteristics at listing, including VAD use were compared between different gender and ethnicity. Kaplan-Meier curves were generated to compare survival in the WL and PT period. 1435 (44%) F were listed for HT during the study period. Compared to males (M), F recipients listed for HT were younger, more likely AA (19 vs. 22%), and cardiomyopathy [CMP] (41.3 vs. 51.4%) [p<0.01 for all]. There were no differences, however, in the use IV inotropes, ventilation, ECMO and dialysis use; Status 1A listing or median WL times [p>0.05 for all]. 663 (20%) AA HT candidates were listed. Compared to Caucasian, AA recipients more likely had CMP (41.3 vs. 49.5%), listed Status 1A (68.7 vs. 72.9%), had renal dysfunction (47.4 s. 53.4%) and were on Medicaid (33.3 vs. 65%) [p<0.01 for all]. While the incidence of IV inotrope use and ICD was lower in AA recipients (50 vs. 48.6% and 9 vs. 5.8% respectively), there was no difference in the incidence of VAD, ECMO, mechanical ventilation and dialysis use. AA recipients had shorter WL times (median 2.1 vs. 2.5 months). While unadjusted WL and PT survival was similar between different gender and race (Figure), multivariate analysis revealed higher waitlist mortality for females [HR 1.2 (1.0-1.5); p=0.04] and African American [HR 1.3 (1.0-1.7); p=0.02] recipients. However, no such difference was seen in post-transplant survival in female [HR 0.9 (0.7-1.2), p=0.35] or AA [1.3 (HR 0.9-1.8), p=0.2] recipients. In the current era, pediatric heart transplant recipients who are F and AA continue to have higher waitlist mortality. Such disparities do not exist post-transplant.