Liu Vincent, Bhattacharya Jay, Weill David, Hlatky Mark A
Divisions of Pulmonary and Critical Care, Stanford University, CA, USA.
Circulation. 2011 Apr 19;123(15):1642-9. doi: 10.1161/CIRCULATIONAHA.110.976811. Epub 2011 Apr 4.
Racial and ethnic disparities are well documented in many areas of health care, but have not been comprehensively evaluated among recipients of heart transplants.
We performed a retrospective cohort study of 39075 adult primary heart transplant recipients from 1987 to 2009 using national data from the United Network of Organ Sharing and compared mortality for nonwhite and white patients using the Cox proportional hazards model. During the study period, 8082 nonwhite and 30 993 white patients underwent heart transplantation. Nonwhite heart transplant recipients increased over time, comprising nearly 30% of transplantations since 2005. Nonwhite recipients had a higher clinical risk profile than white recipients at the time of transplantation, but had significantly higher posttransplantation mortality even after adjustment for baseline risk. Among the nonwhite group, only black recipients had an increased risk of death compared with white recipients after multivariable adjustment for recipient, transplant, and socioeconomic factors (hazard ratio, 1.34; 95% confidence interval, 1.21 to 1.47; P<0.001). Five-year mortality was 35.7% (95% confidence interval, 35.2 to 38.3) among black and 26.5% (95% confidence interval, 26.0 to 27.0) among white recipients. Black patients were more likely to die of graft failure or a cardiovascular cause than white patients, but less likely to die of infection or malignancy. Although mortality decreased over time for all transplant recipients, the disparity in mortality between blacks and whites remained essentially unchanged.
Black heart transplant recipients have had persistently higher mortality than whites recipients over the past 2 decades, perhaps because of a higher rate of graft failure.
种族和民族差异在医疗保健的许多领域都有充分记录，但在心脏移植受者中尚未得到全面评估。
我们利用器官共享联合网络的全国数据，对1987年至2009年的39075例成年原发性心脏移植受者进行了一项回顾性队列研究，并使用Cox比例风险模型比较了非白人患者和白人患者的死亡率。在研究期间，8082例非白人患者和30993例白人患者接受了心脏移植。非白人心脏移植受者的数量随时间增加，自2005年以来占移植手术的近30%。非白人受者在移植时的临床风险特征高于白人受者，但即使在对基线风险进行调整后，其移植后的死亡率仍显著更高。在非白人组中，只有黑人受者在对受者、移植和社会经济因素进行多变量调整后，与白人受者相比死亡风险增加（风险比，1.34；95%置信区间，1.21至1.47；P<0.001）。黑人受者的五年死亡率为35.7%（95%置信区间，35.2至38.3），白人受者为26.5%（95%置信区间，26.0至27.0）。黑人患者死于移植物衰竭或心血管原因的可能性高于白人患者，但死于感染或恶性肿瘤的可能性低于白人患者。尽管所有移植受者的死亡率随时间下降，但黑人和白人之间的死亡率差异基本保持不变。
在过去20年中，黑人心脏移植受者的死亡率一直高于白人受者，这可能是由于移植物衰竭率较高。
