Disparities in outcome for black patients after pediatric heart transplantation.
OBJECTIVE
To examine the relationship of black race to graft survival after heart transplantation in children.


METHODS
United Network for Organ Sharing records of heart transplantation for subjects <18 years of age from 1987 to 2004 were reviewed. Analysis was performed using proportional hazards regression controlling for other potential risk factors.


RESULTS
Of the 4227 pediatric heart transplant recipients, 717 (17%) were black. The 1-year graft survival rate did not differ among groups; however, the 5-year graft survival rate was significantly lower for black recipients, 51% versus 69%, P < .001. The median graft survival for black recipients was 5.3 years as compared with 11.0 years for other recipients. Black recipients had a greater number of human leukocyte antigen mismatches, lower median household income, and a greater percentage with Medicaid as primary insurance, P < .001, P < .001, and P < .001. After adjusting for economic disparities, black race remained significantly associated with graft failure, odds ratio = 1.67 (95% CI 1.47 to 1.87), P < .001.


CONCLUSIONS
Median graft survival after pediatric heart transplantation for black recipients is less than half that of other racial groups. These differences do not appear to be related primarily to economic disparities.
Mahle
William T
WT
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga 30322-1062, USA. wmahle@emory.edu
Kanter
Kirk R
KR
Vincent
Robert N
RN
D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000208:ethnology*; D016027:Heart Transplantation / Q000191:economics / Q000208:ethnology*; D006801:Humans; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology