Elsevier

Journal of Cardiac Failure

Volume 27, Issue 9, September 2021, Pages 957-964
Journal of Cardiac Failure

Racial and Ethnic Disparities Persist in the Current Era of Pediatric Heart Transplantation

https://doi.org/10.1016/j.cardfail.2021.05.027Get rights and content

ABSTRACT

Background

Previous studies have demonstrated that children in the United States who were of racial and ethnic minorities have inferior waitlist and post-heart transplant (HT) outcomes. Whether these disparities still exist in the contemporary era of increased ventricular assist device use remains unknown.

Methods

All children (age <18 years) in the Scientific Registry of Transplant Recipients database listed for HT from December 2011 to February 2019 were included and were separated into 5 races/ethnicities: Caucasian, African American, Hispanic, Asian, and Other. Differences in clinical characteristics and survival among children of different racial/ethnic groups were compared at listing and at HT.

Results

The waitlist cohort consisted of 2134 (52.2%) Caucasian, 840 (20.5%) African American, 808 (19.8%) Hispanic, 161 (3.9%) Asian, and 146 children of Other races (3.6%). At listing, Asian children mostly had cardiomyopathy (70.8%), whereas Caucasian children had congenital heart disease (58.7%). African American children were most likely to be listed as Status 1A and to have renal dysfunction and hypoalbuminemia at listing. African American and Hispanic children were most likely to be on Medicaid. After multivariable analysis, it was found that only African American children were at increased risk for waitlist mortality as compared to Caucasian children (adjusted hazard ratio = 1.25; P = 0.029). Post-HT, there were no disparities in early and midterm graft survival among groups, but African American children had increased numbers of rejection episodes compared to Caucasian and Hispanic children.

Conclusion

African American children continue to experience increased waitlist mortality and have increased rejection episodes post-HT. Studies exploring barriers to health care access and implicit bias as reasons for these disparities need to be conducted.

Section snippets

Study Population

All pediatric patients (age <18 years) listed for primary heart transplantation in the national Scientific Registry of Transplant Recipients (SRTR) database from December 16, 2011 (date of FDA approval of Berlin EXCOR), to February 28, 2019, were included in this study. We excluded patients listed for heart-lung transplantation (n = 43), lung transplantation (n = 394) and retransplantation (n = 243).

SRTR Database

The SRTR data system includes data for all donors, waitlist candidates and transplant recipients

Waitlist Cohort

A total of 4089 pediatric patients listed for heart transplantation were included in our analysis. Of these, 2134 (52.2%) were Caucasian, 840 (20.5%) African American, 808 (19.8%) Hispanic, 161 (3.9%) Asian, and 146 Other (3.6%). From 2012 to 2018, the relative percentage of children from various races and ethnicities listed for heart transplantation remained the same, except in 2014, 2015 and 2017, when there were more Hispanic than African American children (Fig. 1).

Differences in Characteristics Among Children of Differing Races/Ethnicities at Listing

The majority of children

Discussion

There are 3 important findings in our contemporary analysis of pediatric candidates listed for heart transplantation in the U.S. First, African American children listed for heart transplantation in the current era have higher severity of illness at listing and at transplantation. Second, in the current era of rising VAD use in children with advanced heart failure, African American children continue to experience higher waitlist mortality than Caucasian children. Finally, although early and

Acknowledgments

The data reported here have been supplied by the Hennepin Healthcare Research Institute as the contractor for the SRTR. SW and WL had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the analysis. All authors contributed to the design, interpretation of data and drafting of the manuscript along with revisions and participated in the final approval of the manuscript submitted. The interpretation and reporting of these data are the

Disclosures

Dr. Hsich is supported in part by HL141892 from the National Institute of Health. No other authors have any disclosures to report.

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