Heart Transplantation in the United States from 1998 to 2008.

Ravindranath MH, Everly MJ.

Clinical Transplants 2009, Chapter 4

Summary

In The United States, heart transplantation has become a standard treatment for those with end-stage heart disease. The UNOS registry from January 1, 1988 and December 31, 2008 was examined. Heart transplants were performed in 35,670 Caucasian Americans, 6,123 African Americans and 4301 Hispanics, Asian Americans and others. Graft survival rates were 36% at 10 and 54% at 20 years post-transplant for the whole cohort. There was a declining trend (21.5% in the past decade) in the number in Caucasians and an increasing trend (66.6% in the past decade) in the number of African Americans transplanted. Ethnicity emerged as an important factor influencing graft loss. Median survival time was 10.5 years for Caucasians and 7.5 years for African Americans. This difference has not changed over the last 21 years despite many changes to transplant surgery and immunosuppression. Several risk factors of graft loss differed in univariate analyses between the 2 populations. A multivariate analysis of the risk factors of Caucasians and African Americans yielded both similarities and differences. The hazard factors indicative of increased graft loss common to both ethnic groups were posttransplant dialysis and treated rejection. No clear modifiable risk factor stands out that might address the disparity between the groups, although younger African Americans were at highest risk for graft loss. Analysis of other variables in single center and multicenter trials will be necessary to discern possible corrective factors to bridge the gap between the races.