Blitzer David, Pegues J'Undra N, Lirette Seth T, Baran David A, Colvin Monica, Hayanga Awori, Copeland Hannah
Columbia University, Department of Surgery, Division of Cardiovascular Surgery, New York, New York, USA.
University of Mississippi Medical Center, Department of Surgery, Jackson, Mississippi, USA.
Clin Transplant. 2023 Dec;37(12):e15137. doi: 10.1111/ctr.15137. Epub 2023 Sep 19.
There are limited data examining the impact of both donor and recipient race on outcomes following orthotopic heart transplant (OHT). The purpose of this study was to evaluate the relationship between donor and recipient race and OHT outcomes.
The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from January 2000 to March 2018 for donor hearts. A comparison was conducted based on donor and recipient race (White, Black, Hispanic, Other/Unknown). Races for which there were limited numbers were excluded from the analysis (Asian, n = 1292; American Indian, n = 132; Pacific Islander, n = 132, Multiple ethnicities, n = 225). The primary endpoint was survival at 30 days, 1 year survival, and post-transplant rejection. Logistic and Cox models were used to quantify survival endpoints.
A total of 41 841 OHT were included. Of the recipients, 29 894 (71%) were White, 8475 (20%) were Black, and 3472 (8%) were Hispanic. Of the donors 27 783 (66%) were White, 6277 (15%) were Black, 6576 (16%) were Hispanic, and 1205 (3%) were Unknown/Other race. In a comparison of recipient demographics, White recipients were older (54.09 ± 12.21 years) compared to Black (49.44 ± 12.83 years) and Hispanic (49.97 ± 13.27 years) recipients. All other differences between groups were not clinically significant. Black recipients were more likely to receive a heart with an "urgent" status (probability .80) compared to White (.73) and Hispanic (.75) recipients (p < .001). Hispanic recipients were more likely to receive a transplant when listed as "non-urgent" (Probability .47) compared to White (.37) and Black (.30) recipients (p < .001). In terms of outcomes, compared to White recipients, Hispanic patients experienced a decreased 30-day survival (OR 1.27; p = .011) and 1-year survival (OR 1.17; p = .016). In comparing Donor/Recipient combinations compared to a White Donor/White Recipient combination, overall survival was decreased in White donor/African American recipient (HR 1.36; p < .001), African American donor/African American recipient (HR 1.41; p < .001) and Hispanic donor/African American recipient (HR 1.30; p < .001) combinations (Table 1).
African American and Hispanic recipients have decreased survival compared to White recipients after heart transplant. The African American donor does not decrease survival. Racial differences still exist in donor and recipient characteristics and recipient outcomes after OHT. Increasing the donor pool for all races and ethnicities would potentially benefit all recipients. Continued study is warranted in order to minimize these differences among recipients and identify factors that could be contributing to decreased survival, in order to optimize outcomes for African American and Hispanic recipients post-transplant and eliminate disparities.
关于供体和受体种族对原位心脏移植（OHT）术后结局影响的数据有限。本研究旨在评估供体和受体种族与OHT结局之间的关系。
对器官共享联合网络（UNOS）数据库在2000年1月至2018年3月期间的供心进行回顾性分析。根据供体和受体种族（白人、黑人、西班牙裔、其他/未知）进行比较。分析中排除了数量有限的种族（亚洲人，n = 1292；美洲印第安人，n = 132；太平洋岛民，n = 132；多种族，n = 225）。主要终点为30天生存率、1年生存率和移植后排斥反应。采用逻辑回归和Cox模型对生存终点进行量化。
共纳入41841例OHT。在受体中，29894例（71%）为白人，8475例（20%）为黑人，3472例（8%）为西班牙裔。在供体中，27783例（66%）为白人，6277例（15%）为黑人，6576例（16%）为西班牙裔，1205例（3%）为未知/其他种族。在受体人口统计学比较中，白人受体年龄较大（54.09±12.21岁），而黑人受体（49.44±12.83岁）和西班牙裔受体（49.97±13.27岁）年龄较小。各组之间的所有其他差异均无临床意义。与白人受体（概率0.73）和西班牙裔受体（概率0.75）相比，黑人受体更有可能接受“紧急”状态的心脏（概率0.80）（p < 0.001）。与白人受体（概率0.37）和黑人受体（概率0.30）相比，西班牙裔受体在列为“非紧急”时接受移植的可能性更大（概率0.47）（p < 0.001）。在结局方面，与白人受体相比，西班牙裔患者的30天生存率（OR 1.27；p = 0.011）和1年生存率（OR 1.17；p = 0.016）降低。与白人供体/白人受体组合相比，在比较供体/受体组合时，白人供体/非裔美国受体（HR 1.36；p < 0.001）、非裔美国供体/非裔美国受体（HR 1.41；p < 0.0）和西班牙裔供体/非裔美国受体（HR 1.30；p < 0.001）组合的总体生存率降低（表1）。
与白人受体相比，非裔美国人和西班牙裔受体心脏移植后的生存率降低。非裔美国供体不会降低生存率。在OHT后，供体和受体特征以及受体结局方面仍然存在种族差异。增加所有种族和族裔的供体库可能会使所有受体受益。有必要继续进行研究，以尽量减少受体之间的这些差异，并确定可能导致生存率降低的因素，从而优化非裔美国人和西班牙裔受体移植后的结局并消除差异。
