Assessment of U.S. heart transplantation equity as a function of race: Observational analyses of the OPTN database

• Type of Material: Article
• Authors: Rebecca Cogswell, University of Minnesota Twin Cities; Maria Masotti, University of Minnesota, Minneapolis; Alanna Morris, Emory University; Allyson Hart, University of Minnesota, Minneapolis; Tom Murray, University of Minnesota, Minneapolis; Clyde Yancy, Northwestern University Feinberg School of Medicine
• Language: English
• Date: 2022-09-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.lana.2022.100290
• Title of Journal or Parent Work: The Lancet Regional Health - Americas
• Volume: 13
• Start Page: 100290
• End Page: 100290
• Keywords: LVAD, Left ventricular assist device; SVI, social vulnerability index; SES, socioeconomic status; Heart Transplantation; BMI, body mass index; SRTR, Scientific Registry of Transplant Recipient; SDOH, social determinants of health; Disparities; HT, Heart transplantation; MCS, Mechanical Circulatory Support; OPTN, Organ Procurement and Transplantation Network
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background: Racial disparities in heart transplantation (HT) outcomes are suspected but uncertain. The additional impact of a recent change in donor allocation on disparities in HT in the United States (US) is unknown. We hypothesize racial disparities in HT are present and may be worsened by new allocation practices. Methods: Cohort: Adults listed for HT before and after a heart allocation policy change (Era 1: Oct 18th, 2015 - Oct 18th, 2018, Era 2: Oct 18th, 2018-June 30, 2021). The primary outcome was the rate of HT by race (Black vs. White), assessed using multivariable competing risk analysis (compete: waitlist removal for death or clinical deterioration). Final adjusted models included co-morbidities, SES and community-level Social Determinants of Health. The secondary outcome was waitlist removal for death or clinical deterioration. Results: Of 17,384 waitlist candidates (Era 1: 9,150, Era 2: 8,234), Black waitlist candidates had a lower rate of HT compared to White waitlist candidates in Era 1 (adjusted HR 0·90, 95 % CI 0·84-0·97, p = 0·0053) and in Era 2 (adjusted HR 0·81, 95 % CI 0·75-0·88, p <0·0001, era race interaction p=0·056). The rate of waitlist removal for death or deterioration was similar between races in Era 1 (adjusted HR 0·92, 95 % 0·77-1·1, p = 0·38), but increased for Black candidates in Era 2 (adjusted HR 1·34, 95 % CI 1·09-1·65, p = 0·0054, era race interaction p = 0·0051). Interpretation: Both the measured rate of transplantation and rate of delisting for death or clinical deterioration have worsened for Black compared to White waitlist candidates under the new allocation system. Causes for these disparities require further study. Funding: University of Minnesota Department of Cardiology funds.