Racial Disparities in Patients Bridged to Heart Transplantation With Left Ventricular Assist Devices

Cecillia Lui, Charles D. Fraser, Xun Zhou, Alejandro Suarez-Pierre, A. Kilic, Kenton J. Zehr, Robert Higgins

Research output: Contribution to journalArticle

Abstract

Background: Left ventricular assist devices (LVADs) are an effective therapy in bridging patients with end-stage heart failure to heart transplantation. The aim of this study was to identify the role of race in survival of patients bridged to heart transplantation with a LVAD. Methods: The United Network of Organ Sharing database was queried for all adult heart transplant recipients (age 18 years or older) who were bridged to transplantation with a LVAD from 2005 to 2018. Patients were stratified based on their race, with whites as the reference group. Demographic characteristics, 5-year survival, and graft failure after transplantation were assessed with χ2 test, analysis of variance, Kaplan-Meier survival analyses, log-rank tests, and Cox proportional hazards modeling or logistic regression modeling as appropriate. Results: Patients (N = 6476) successfully bridged with a LVAD to heart transplantation were identified. There were 4263 whites, 1536 African Americans, 508 Hispanics, and 169 Asians. Compared with whites, African Americans had higher body mass indexes, were more likely to be women, pay with private insurance, and be working for income at the time of transplantation. African Americans were found to have increased odds of graft failure (odds ratio 1.27, P = .048) compared with whites. In addition, African Americans were found to have increased risk of mortality at 5 years (hazard ratio 1.26, P = .003). Conclusions: The African American race is associated with increased rates of graft failure after transplantation and decreased 5-year survival compared with the white race. Given these findings, directed clinical attention may be warranted in African American patients bridged to heart transplantation with a LVAD.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Heart-Assist Devices
Heart Transplantation
African Americans
Transplantation
Transplants
Survival
Kaplan-Meier Estimate
Graft Survival
Survival Analysis
Insurance
Hispanic Americans
Analysis of Variance
Body Mass Index
Heart Failure
Logistic Models
Odds Ratio
Demography
Databases
Mortality

ASJC Scopus subject areas

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

Cite this

Racial Disparities in Patients Bridged to Heart Transplantation With Left Ventricular Assist Devices. / Lui, Cecillia; Fraser, Charles D.; Zhou, Xun; Suarez-Pierre, Alejandro; Kilic, A.; Zehr, Kenton J.; Higgins, Robert.

In: Annals of Thoracic Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Lui, Cecillia ; Fraser, Charles D. ; Zhou, Xun ; Suarez-Pierre, Alejandro ; Kilic, A. ; Zehr, Kenton J. ; Higgins, Robert. / Racial Disparities in Patients Bridged to Heart Transplantation With Left Ventricular Assist Devices. In: Annals of Thoracic Surgery. 2019.
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abstract = "Background: Left ventricular assist devices (LVADs) are an effective therapy in bridging patients with end-stage heart failure to heart transplantation. The aim of this study was to identify the role of race in survival of patients bridged to heart transplantation with a LVAD. Methods: The United Network of Organ Sharing database was queried for all adult heart transplant recipients (age 18 years or older) who were bridged to transplantation with a LVAD from 2005 to 2018. Patients were stratified based on their race, with whites as the reference group. Demographic characteristics, 5-year survival, and graft failure after transplantation were assessed with χ2 test, analysis of variance, Kaplan-Meier survival analyses, log-rank tests, and Cox proportional hazards modeling or logistic regression modeling as appropriate. Results: Patients (N = 6476) successfully bridged with a LVAD to heart transplantation were identified. There were 4263 whites, 1536 African Americans, 508 Hispanics, and 169 Asians. Compared with whites, African Americans had higher body mass indexes, were more likely to be women, pay with private insurance, and be working for income at the time of transplantation. African Americans were found to have increased odds of graft failure (odds ratio 1.27, P = .048) compared with whites. In addition, African Americans were found to have increased risk of mortality at 5 years (hazard ratio 1.26, P = .003). Conclusions: The African American race is associated with increased rates of graft failure after transplantation and decreased 5-year survival compared with the white race. Given these findings, directed clinical attention may be warranted in African American patients bridged to heart transplantation with a LVAD.",
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