Azap Lovette, Diaz Adrian, Gouchoe Doug A, Mokadam Nahush A, Smith Sakima, Henn Matthew C, Whitson Bryan A, Habib Alim, Lampert Brent C, Pawlik Timothy M, Ganapathi Asvin M
Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
JHLT Open. 2024 Mar 2;4:100079. doi: 10.1016/j.jhlto.2024.100079. eCollection 2024 May.
The association of social vulnerability (SV) and cardiac transplant survival remains poorly defined, particularly related to long-term outcomes. The purpose of this study was to define the impact of SV on survival among heart transplant recipients with at least 1 year of survival post-transplant.
Heart transplant recipients were identified using the United Network for Organ Sharing database between June 1, 2006, and December 31, 2020. The Center for Disease Control's Social Vulnerability Index (SVI) database was used to stratify patients based on SVI into 3 groups: low: <25; average: 26 to 74; high: 75+. The groups were analyzed with comparative statistics, and unadjusted survival was assessed using Kaplan-Meier methods. To determine the independent association between SVI and survival, a multivariable Cox proportional hazard model was created.
There were 27,740 recipients identified. High SVI patients more commonly identified as Black individuals and had a higher incidence of diabetes, pretransplant intensive care unit admission, and need for concomitant kidney transplant ( < 0.05 for all). Additionally, high SVI patients had the longest length of stay post-transplant (21.4 days) ( < 0.05). High and average SVI patients had inferior 3-year, 5-year, and 10-year survival vs low SVI patients ( < 0.05). After adjustment, average (hazard ratio [HR]: 1.12) and high (HR: 1.16) SVI were independently associated with an increased risk of mortality on multivariable analysis (both < 0.001).
High or average SVI is independently associated with increased mortality following heart transplantation in patients with 1-year conditional survival. These findings demonstrate that disparities persist among heart transplant recipients during long-term follow-up.
社会脆弱性（SV）与心脏移植存活率之间的关联仍不明确，尤其是与长期预后相关的方面。本研究的目的是确定SV对移植后至少存活1年的心脏移植受者生存率的影响。
利用器官共享联合网络数据库确定2006年6月1日至2020年12月31日期间的心脏移植受者。使用疾病控制中心的社会脆弱性指数（SVI）数据库，根据SVI将患者分为3组：低：<25；中等：26至74；高：75+。采用比较统计方法对各组进行分析，并使用Kaplan-Meier方法评估未调整的生存率。为了确定SVI与生存率之间的独立关联，建立了多变量Cox比例风险模型。
共确定了27740名受者。高SVI患者更常被认定为黑人，糖尿病、移植前入住重症监护病房以及需要同时进行肾移植的发生率更高（所有P<0.05）。此外，高SVI患者移植后的住院时间最长（21.4天）（P<0.05）。高SVI和中等SVI患者的3年、5年和10年生存率低于低SVI患者（P<0.05）。调整后，中等（风险比[HR]：1.12）和高（HR：1.16）SVI在多变量分析中与死亡风险增加独立相关（均P<0.001）。
高或中等SVI与有1年条件生存率的患者心脏移植后死亡率增加独立相关。这些发现表明，在长期随访中，心脏移植受者之间的差异仍然存在。
