Improving Trends in 6-month Mortality after Heart Transplant in White vs. Black Recipients

Abstract

<h3>Purpose</h3> We previously reported improving 30-year trends in short-term heart transplant outcomes using Scientific Registry of Transplant Recipients (SRTR). While racial disparities in transplant outcomes are well-documented, how these improving trends differ by racial subgroups has not been studied. <h3>Methods</h3> Using SRTR, we identified all adult heart recipients with racial subgroups white or black. Temporal changes in recipients, donors, and providers were described. Outcome of all-cause death 6 months post-transplant was analyzed by race. Multivariable modified Poisson regression estimated yearly risk of mortality compared to 1989 adjusted for population characteristics and tested for race-year interaction. <h3>Results</h3> Among 58,204 heart recipients, frequency of black recipients increased 8.6%-23.9% from 1989-2017. Known risk factors (<i>e.g.</i> age ≥ 55, IABP) were more frequent in white and increased over 30 years in both groups. More black recipients had initial urgency of Status 1a/b. In black recipients, 9.5% experienced all-cause death within 6 months of transplant compared to 10.2% of white. Adjusting for population characteristics, mortality risk in black recipients was 13% higher relative to white recipients (p<0.05); yet we observed similar improving trends in 6-month mortality over time in black and white recipients (p=0.98). <h3>Conclusion</h3> From 1989 to 2017, an increasing proportion of heart recipients are black, a racial subgroup that continues to be associated with heightened mortality risk within 6 months post-transplant. Nevertheless, 30-year trends in short-term outcomes have been improving irrespective of recipient race.