Elsevier

The Journal of Pediatrics

Volume 147, Issue 6, December 2005, Pages 739-743
The Journal of Pediatrics

Original Article
Disparities in Outcome for Black Patients after Pediatric Heart Transplantation

https://doi.org/10.1016/j.jpeds.2005.07.018Get rights and content

Objective

To examine the relationship of black race to graft survival after heart transplantation in children.

Study design

United Network for Organ Sharing records of heart transplantation for subjects <18 years of age from 1987 to 2004 were reviewed. Analysis was performed using proportional hazards regression controlling for other potential risk factors.

Results

Of the 4227 pediatric heart transplant recipients, 717 (17%) were black. The 1-year graft survival rate did not differ among groups; however, the 5-year graft survival rate was significantly lower for black recipients, 51% versus 69%, P < .001. The median graft survival for black recipients was 5.3 years as compared with 11.0 years for other recipients. Black recipients had a greater number of human leukocyte antigen mismatches, lower median household income, and a greater percentage with Medicaid as primary insurance, P < .001, P < .001, and P < .001. After adjusting for economic disparities, black race remained significantly associated with graft failure, odds ratio = 1.67 (95% CI 1.47 to 1.87), P < .001.

Conclusions

Median graft survival after pediatric heart transplantation for black recipients is less than half that of other racial groups. These differences do not appear to be related primarily to economic disparities.

Section snippets

Methods

This study was carried out with approval from the Institutional Review Board of Children's Healthcare of Atlanta. Data for this analysis were supplied by UNOS. From 1987 to 2004 there were 4227 children, ages 17 years or younger, who underwent heart transplantation. The data set consisted of the Transplant Candidate Registration form and Transplant Recipient Registration form, and the Transplant Recipient follow-up form. The follow-up form was administered annually.

To explore the relationship

Results

During the study period 4227 heart transplants were studied. There were 4008 primary transplants and 219 repeat transplants for subjects with prior graft failure. Of the 4227 pediatric heart transplant recipients, 717 (17%) were black. The median age at transplantation for the entire cohort was 3 years. The 2 most common indications for transplantation were congenital heart disease in 2032 (48%) and dilated cardiomyopathy in 1163 (28%). The freedom from graft failure for the entire cohort was

Discussion

This study demonstrates that black children who undergo heart transplantation have significantly lower graft survival rates when compared with recipients of other races. In this large cohort covering more than 16 years of the pediatric transplantation experience, the median graft survival after heart transplantation in black children was 5.3 years compared with 11.0 years for other recipients. These differences do not appear to be related to disparities in household income or insurance status.

References (29)

  • R.E. Shaddy et al.

    Outcome of cardiac transplantation in children. Survival in a contemporary multi-institutional experience. Pediatric Heart Transplant Study

    Circulation

    (1996)
  • P. Gupta et al.

    Risk factors for chronic rejection after pediatric liver transplantation

    Transplantation

    (2001)
  • M.R. Benfield et al.

    The 1997 Annual Renal Transplantation in Children Report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

    Pediatr Transplant

    (1999)
  • US Bureau of the Census

    Intercensal Estimates of the Population of States by Age, Sex, and Race: 1970–2000

    (2002)
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