The Impact of Race on Survival After Heart Transplantation: An Analysis of More Than 20,000 Patients

Jeremiah G. Allen, Eric S. Weiss, George J. Arnaoutakis, Stuart D. Russell, William A. Baumgartner, John Conte, Ashish S. Shah

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background: Evidence exists for race-linked discrepancies in survival after orthotopic heart transplantation (OHT). The United Network for Organ Sharing database provides an opportunity to examine the effect of race on outcomes in a large cohort of adult OHT patients. Methods: We retrospectively reviewed the United Network for Organ Sharing data for 20,185 adult patients receiving primary OHT (1997 through 2007). Patients were divided into groups of specific race and also stratified by donor and recipient race-matching. The impact of race on mortality was examined using multivariable Cox proportional hazard regression analysis incorporating 23 variables and interaction terms between donor and recipient race. Mortality (30 days, 90 days, 1 year, 2 years, and 5 years) and rejection in the first year were examined. Cumulative post-OHT survival was modeled using the Kaplan-Meier method. Results: Of 20,185 patients, 12,381 (61%) were race matched (75% of whites, n = 11,456; 17% of African Americans, n = 514; 30% of Hispanics, n = 391; 5% of Asians, n = 19). Five thousand six hundred fourteen patients (28%) died during the study. African American recipients have an 11.4% absolute decrease in 10-year survival compared with whites. After risk adjustment, African American recipients have a 46% increase in the risk of cumulative mortality (hazard ratio, 1.46; 95% confidence interval, 1.24 to 1.72; p < 0.001). Decreased survival in African American recipients was not improved with race-matched OHT, nor was there a survival advantage with race-matching in any racial subgroup. Decreased survival in African American recipients persisted after censoring deaths in the first year. Conclusions: Our study represents the largest modern cohort evaluating race in adult OHT. African American recipients have significantly worse survival after OHT. Race-matching did not confer improved survival.

Original languageEnglish (US)
Pages (from-to)1956-1964
Number of pages9
JournalAnnals of Thoracic Surgery
Volume89
Issue number6
DOIs
StatePublished - Jun 1 2010

Fingerprint

Heart Transplantation
Survival
African Americans
Mortality
Tissue Donors
Risk Adjustment
Information Dissemination
Hispanic Americans
Regression Analysis
Databases
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Allen, J. G., Weiss, E. S., Arnaoutakis, G. J., Russell, S. D., Baumgartner, W. A., Conte, J., & Shah, A. S. (2010). The Impact of Race on Survival After Heart Transplantation: An Analysis of More Than 20,000 Patients. Annals of Thoracic Surgery, 89(6), 1956-1964. https://doi.org/10.1016/j.athoracsur.2010.02.093
Allen, Jeremiah G. ; Weiss, Eric S. ; Arnaoutakis, George J. ; Russell, Stuart D. ; Baumgartner, William A. ; Conte, John ; Shah, Ashish S. / The Impact of Race on Survival After Heart Transplantation : An Analysis of More Than 20,000 Patients. In: Annals of Thoracic Surgery. 2010 ; Vol. 89, No. 6. pp. 1956-1964.
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abstract = "Background: Evidence exists for race-linked discrepancies in survival after orthotopic heart transplantation (OHT). The United Network for Organ Sharing database provides an opportunity to examine the effect of race on outcomes in a large cohort of adult OHT patients. Methods: We retrospectively reviewed the United Network for Organ Sharing data for 20,185 adult patients receiving primary OHT (1997 through 2007). Patients were divided into groups of specific race and also stratified by donor and recipient race-matching. The impact of race on mortality was examined using multivariable Cox proportional hazard regression analysis incorporating 23 variables and interaction terms between donor and recipient race. Mortality (30 days, 90 days, 1 year, 2 years, and 5 years) and rejection in the first year were examined. Cumulative post-OHT survival was modeled using the Kaplan-Meier method. Results: Of 20,185 patients, 12,381 (61{\%}) were race matched (75{\%} of whites, n = 11,456; 17{\%} of African Americans, n = 514; 30{\%} of Hispanics, n = 391; 5{\%} of Asians, n = 19). Five thousand six hundred fourteen patients (28{\%}) died during the study. African American recipients have an 11.4{\%} absolute decrease in 10-year survival compared with whites. After risk adjustment, African American recipients have a 46{\%} increase in the risk of cumulative mortality (hazard ratio, 1.46; 95{\%} confidence interval, 1.24 to 1.72; p < 0.001). Decreased survival in African American recipients was not improved with race-matched OHT, nor was there a survival advantage with race-matching in any racial subgroup. Decreased survival in African American recipients persisted after censoring deaths in the first year. Conclusions: Our study represents the largest modern cohort evaluating race in adult OHT. African American recipients have significantly worse survival after OHT. Race-matching did not confer improved survival.",
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The Impact of Race on Survival After Heart Transplantation : An Analysis of More Than 20,000 Patients. / Allen, Jeremiah G.; Weiss, Eric S.; Arnaoutakis, George J.; Russell, Stuart D.; Baumgartner, William A.; Conte, John; Shah, Ashish S.

In: Annals of Thoracic Surgery, Vol. 89, No. 6, 01.06.2010, p. 1956-1964.

Research output: Contribution to journalArticle

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T1 - The Impact of Race on Survival After Heart Transplantation

T2 - An Analysis of More Than 20,000 Patients

AU - Allen, Jeremiah G.

AU - Weiss, Eric S.

AU - Arnaoutakis, George J.

AU - Russell, Stuart D.

AU - Baumgartner, William A.

AU - Conte, John

AU - Shah, Ashish S.

PY - 2010/6/1

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N2 - Background: Evidence exists for race-linked discrepancies in survival after orthotopic heart transplantation (OHT). The United Network for Organ Sharing database provides an opportunity to examine the effect of race on outcomes in a large cohort of adult OHT patients. Methods: We retrospectively reviewed the United Network for Organ Sharing data for 20,185 adult patients receiving primary OHT (1997 through 2007). Patients were divided into groups of specific race and also stratified by donor and recipient race-matching. The impact of race on mortality was examined using multivariable Cox proportional hazard regression analysis incorporating 23 variables and interaction terms between donor and recipient race. Mortality (30 days, 90 days, 1 year, 2 years, and 5 years) and rejection in the first year were examined. Cumulative post-OHT survival was modeled using the Kaplan-Meier method. Results: Of 20,185 patients, 12,381 (61%) were race matched (75% of whites, n = 11,456; 17% of African Americans, n = 514; 30% of Hispanics, n = 391; 5% of Asians, n = 19). Five thousand six hundred fourteen patients (28%) died during the study. African American recipients have an 11.4% absolute decrease in 10-year survival compared with whites. After risk adjustment, African American recipients have a 46% increase in the risk of cumulative mortality (hazard ratio, 1.46; 95% confidence interval, 1.24 to 1.72; p < 0.001). Decreased survival in African American recipients was not improved with race-matched OHT, nor was there a survival advantage with race-matching in any racial subgroup. Decreased survival in African American recipients persisted after censoring deaths in the first year. Conclusions: Our study represents the largest modern cohort evaluating race in adult OHT. African American recipients have significantly worse survival after OHT. Race-matching did not confer improved survival.

AB - Background: Evidence exists for race-linked discrepancies in survival after orthotopic heart transplantation (OHT). The United Network for Organ Sharing database provides an opportunity to examine the effect of race on outcomes in a large cohort of adult OHT patients. Methods: We retrospectively reviewed the United Network for Organ Sharing data for 20,185 adult patients receiving primary OHT (1997 through 2007). Patients were divided into groups of specific race and also stratified by donor and recipient race-matching. The impact of race on mortality was examined using multivariable Cox proportional hazard regression analysis incorporating 23 variables and interaction terms between donor and recipient race. Mortality (30 days, 90 days, 1 year, 2 years, and 5 years) and rejection in the first year were examined. Cumulative post-OHT survival was modeled using the Kaplan-Meier method. Results: Of 20,185 patients, 12,381 (61%) were race matched (75% of whites, n = 11,456; 17% of African Americans, n = 514; 30% of Hispanics, n = 391; 5% of Asians, n = 19). Five thousand six hundred fourteen patients (28%) died during the study. African American recipients have an 11.4% absolute decrease in 10-year survival compared with whites. After risk adjustment, African American recipients have a 46% increase in the risk of cumulative mortality (hazard ratio, 1.46; 95% confidence interval, 1.24 to 1.72; p < 0.001). Decreased survival in African American recipients was not improved with race-matched OHT, nor was there a survival advantage with race-matching in any racial subgroup. Decreased survival in African American recipients persisted after censoring deaths in the first year. Conclusions: Our study represents the largest modern cohort evaluating race in adult OHT. African American recipients have significantly worse survival after OHT. Race-matching did not confer improved survival.

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