Department of Pediatrics, University of Alabama Birmingham, Birmingham, AL, USA.
Heart Transplant Program, Children's of Alabama, Birmingham, AL, USA.
Pediatr Transplant. 2021 Jun;25(4):e13979. doi: 10.1111/petr.13979. Epub 2021 Feb 1.
Racial disparities have been reported among pediatric patients waitlisted for and undergoing heart transplantation but have not been studied further upstream in the transplant candidate evaluation process. We retrospectively studied our single-center experience in order to investigate any potential biases in the evaluation process. Results of the heart transplant evaluation in children ≤18 years old at our institution were analyzed. Primary outcome was final disposition to waitlist or not. Race was defined by family self-identification. Descriptive and comparative statistical analyses were performed. From 2013 to 2019, 133 unique patients were referred for listing consideration. While Black patients comprised 44% of the referral population and had more markers of socioeconomic disadvantage, they comprised 43% of the patients who were listed for transplantation with no significant difference between these proportions (p = .96). Black and White patients made up a similar proportion of patients deemed too well or too ill for listing. Black patients had lower annual household income estimates and rates of household marriage. Despite identifying significant social challenges in 27 patients (18 of them Black), only five patients (3 Black and 2 White) were turned down for listing due to social barriers. While limited by the small number of patients turned down for social barriers, our transplant evaluation process does not appear to result in racial disparities in access to listing. Further studies are needed using national cohorts to explore possible racial disparities upstream from waitlisting and transplantation, such as during the referral and evaluation.
种族差异在等待和接受心脏移植的儿科患者中已有报道，但在移植候选人评估过程的上游尚未进一步研究。我们回顾性地研究了我们的单中心经验，以调查评估过程中是否存在任何潜在的偏见。分析了我们机构 18 岁以下儿童的心脏移植评估结果。主要结局是最终是否列入候补名单。种族由家庭自我认同定义。进行了描述性和比较性统计分析。2013 年至 2019 年，共有 133 名患者被转介进行列表评估。尽管黑人患者占转诊人群的 44%，且具有更多的社会经济劣势标志物，但他们占列入移植名单的患者的 43%，这两个比例之间没有显著差异（p =.96）。黑人患者和白人患者在被认为不适合或太适合列入名单的患者中所占比例相似。黑人患者的家庭年收入估计值和家庭婚姻率较低。尽管有 27 名患者（其中 18 名是黑人）存在明显的社会挑战，但由于社会障碍，只有 5 名患者（3 名黑人，2 名白人）被拒绝列入名单。尽管由于被拒绝列入名单的社会障碍的患者数量有限，但我们的移植评估过程似乎不会导致在列入名单方面存在种族差异。需要使用全国队列进一步研究在候补名单和移植之前的上游可能存在的种族差异，例如在转诊和评估期间。
