Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ann Thorac Surg. 2019 Oct;108(4):1122-1126. doi: 10.1016/j.athoracsur.2019.03.073. Epub 2019 Apr 26.
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.
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 χ test, analysis of variance, Kaplan-Meier survival analyses, log-rank tests, and Cox proportional hazards modeling or logistic regression modeling as appropriate.
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).
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.
左心室辅助装置（LVAD）是将终末期心力衰竭患者桥接至心脏移植的有效治疗方法。本研究旨在确定种族在使用 LVAD 桥接至心脏移植的患者生存中的作用。
从 2005 年至 2018 年，利用美国器官共享网络数据库检索所有接受 LVAD 桥接心脏移植的成年心脏移植受者（年龄 18 岁或以上）。根据种族对患者进行分层，以白种人作为参考组。使用 χ2 检验、方差分析、Kaplan-Meier 生存分析、对数秩检验和 Cox 比例风险模型或逻辑回归模型评估人口统计学特征、5 年生存率和移植后移植物衰竭。
成功接受 LVAD 桥接心脏移植的患者（N=6476）。其中白人 4263 例，非裔美国人 1536 例，西班牙裔 508 例，亚裔 169 例。与白人相比，非裔美国人的体重指数更高，女性更多，在移植时更有可能通过私人保险支付费用并为收入而工作。与白人相比，非裔美国人的移植物衰竭的几率更高（比值比 1.27，P=0.048）。此外，非裔美国人的 5 年死亡率也更高（风险比 1.26，P=0.003）。
与白人相比，非裔美国人种族与移植后移植物衰竭率增加和 5 年生存率降低相关。鉴于这些发现，对接受 LVAD 桥接心脏移植的非裔美国患者可能需要给予有针对性的临床关注。
