Racial Disparity Exists in the Utilization of and Post-Transplant Survival Benefit from Ventricular Assist Device Support in Children

Abstract

<h3>Purpose</h3> Despite advances in the field of pediatric heart failure, black patients continue to experience inferior outcomes. Studies have reported that ventricular assist device (VAD) bridge to transplant (BTT) is associated with similar or better post-transplant survival (PTS) versus no MCS, but whether race/ethnicity affect this is unclear. <h3>Methods</h3> UNOS was used to identify patients <18 years old at listing who received heart transplantation during or after 2006. Patients were grouped by race/ethnicity - black (B; n=1,294), Hispanic (H; n=1,218), and white (W; n=3,395) - and demographics, VAD utilization, clinical status, and PTS were compared. Multivariate (MV) Cox proportional analysis was performed to identify predictors of survival. <h3>Results</h3> Black patients were oldest and heaviest (p<0.01 for both). Dilated cardiomyopathy was more prevalent in non-whites (p<0.01) and congenital heart disease more prevalent in whites (p<0.01). Less consistent trends were seen in functional impairment and organ dysfunction (Table). VAD utilization at time of transplant was greatest in black patients (B-28%, H-23%, W-21%, p<0.01). Kaplan-Meier PTS was higher in whites than in blacks or Hispanics (W-B, p<0.01; W-H, p=0.01) (Figure). On MV analysis of PTS, white BTT with VAD was protective (HR 0.66 (95% CI 0.52-0.84), p<0.01). <h3>Conclusion</h3> VAD utilization is greatest in black children. The post-transplant survival benefit portended by VAD in whites is not seen in non-whites despite a greater percentage having a more favorable cardiac diagnosis and controlling for preoperative variables.