The impact of race on survival after heart transplantation: an analysis of more than 20,000 patients.

BACKGROUND Evidence exists for race-linked discrepancies in survival after orthotopic heart transplantation (OHT). The United Network for Organ Sharing database provides an opportunity to examine the effect of race on outcomes in a large cohort of adult OHT patients. METHODS We retrospectively reviewed the United Network for Organ Sharing data for 20,185 adult patients receiving primary OHT (1997 through 2007). Patients were divided into groups of specific race and also stratified by donor and recipient race-matching. The impact of race on mortality was examined using multivariable Cox proportional hazard regression analysis incorporating 23 variables and interaction terms between donor and recipient race. Mortality (30 days, 90 days, 1 year, 2 years, and 5 years) and rejection in the first year were examined. Cumulative post-OHT survival was modeled using the Kaplan-Meier method. RESULTS Of 20,185 patients, 12,381 (61%) were race matched (75% of whites, n = 11,456; 17% of African Americans, n = 514; 30% of Hispanics, n = 391; 5% of Asians, n = 19). Five thousand six hundred fourteen patients (28%) died during the study. African American recipients have an 11.4% absolute decrease in 10-year survival compared with whites. After risk adjustment, African American recipients have a 46% increase in the risk of cumulative mortality (hazard ratio, 1.46; 95% confidence interval, 1.24 to 1.72; p < 0.001). Decreased survival in African American recipients was not improved with race-matched OHT, nor was there a survival advantage with race-matching in any racial subgroup. Decreased survival in African American recipients persisted after censoring deaths in the first year. CONCLUSIONS Our study represents the largest modern cohort evaluating race in adult OHT. African American recipients have significantly worse survival after OHT. Race-matching did not confer improved survival.