Improving Heart Transplant Outcomes in the African American Population? Are We There Yet?

Abstract

<h3>Purpose</h3> Heart failure (HF) related deaths in Southern United States (SUS), where majority of the African American (AA) population lives, is 202.5/100,000 of population, and is significantly higher than median of 189.5 deaths for rest of US. We sought to investigate the heart transplant (HTX) trends and post-transplant outcomes in the AA population over the years. <h3>Methods</h3> United Network for Organ Sharing (UNOS) registry was analyzed for all adult HTX recipients (HTR) from 1999 to 2018. Two groups were evaluated (Group 1: AA, Group 2: All others) over 5 year intervals (Time A:1998-2003, B:2003-2008, C:2008-2013, D:2013-2018) and organ allocation regions (south: region 3&11 vs Other (rest of US)). Chi-square, trend test and Kaplan- Meier survival analysis were applied to analyze HTX trends over time, and long-term survival and hazard ratios were analyzed by cox regression modeling. <h3>Results</h3> 35,566 patients received HTX, with 6,737 (18%) being AA with mean age of 52.9±12.5 years. In AA HTR 2224 (33%) were female. Of 8464 HTR in SUS, 2635 (31%) were AA with progressive increase in HTX in every 5 year time interval (Time A-20%, B-26%, C-30%, D-33%)(p<0.0001) and demonstrated statistical significance after adjusting for confounding variables (p<0.0001). KM survival analysis in HTR-AA during the four-time intervals showed progressive increase in survival (Fig). However, HTR-AA had increased risk of death in all time periods (Time A: 27%, B: 36%, C: 25%) from 1999-2013 in comparison to rest of population. <h3>Conclusion</h3> Burden of heart failure is higher in SUS, and resources are needed to improve HF management, improve access to HF therapies including HTX, and devise new strategies to improve HTX outcomes in AA.