title: Improved survival in heart transplant recipients in the United States: racial differences in era effect.
abstract: BACKGROUND
  Posttransplant survival in heart transplant recipients has progressively improved during the past 2 decades. It is unknown, however, whether the major racial groups in the United States have benefited equally.
  
  
  RESULTS
  We analyzed all primary heart transplant recipients aged ≥18 years in the United States from 1987 to 2008. We compared posttransplant survival in white, black, and Hispanic recipients in 5 successive eras (1987 to 1992, 1993 to 1996, 1997 to 2000, 2001 to 2004, 2005 to 2008). Early survival was defined as freedom from death or retransplantation during the first 6 months posttransplant. Longer-term, conditional survival was assessed in patients who survived the first 6 months. There were 29 986 (81.6%) white, 4745 (12.9%) black, and 2017 (5.5%) Hispanic patients in the study cohort. Black patients were at increased risk of early death or retransplant (hazard ratio [HR], 1.15; 95% CI, 1.05 to 1.26) in adjusted analysis. Early posttransplant survival improved (HR, 0.83; 95% CI, 0.80 to 0.87 for successive eras) equally in all 3 groups (black-era interaction, P=0.94; Hispanic-era interaction, P=0.40). Longer-term survival improved in white (HR, 0.95; 95% CI, 0.92 to 0.97 for successive eras) but not in black (HR, 1.04; 95% CI, 0.99 to 1.09) or Hispanic (HR, 1.02; 95% CI, 0.95 to 1.09) recipients, resulting in increased disparities in longer-term survival with time.
  
  
  CONCLUSIONS
  Early posttransplant survival has improved equally in white, black, and Hispanic heart transplant recipients. Longer-term survival has improved in white but not in black or Hispanic recipients, resulting in a more marked disparity in outcomes in the current era. These disparities warrant further investigation and targeted interventions.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA. TP.Singh@cardio.chboston.org
authors.forename: Tajinder P
authors.initials: TP
authors.lastname: Singh
authors.forename: Christopher
authors.initials: C
authors.lastname: Almond
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.forename: Gary
authors.initials: G
authors.lastname: Piercey
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D005260:Female; D006084:Graft Rejection / Q000208:ethnology* / Q000401:mortality / Q000517:prevention & control; D006085:Graft Survival; D019538:Health Care Surveys; D054624:Health Status Disparities; D016027:Heart Transplantation / Q000009:adverse effects / Q000208:ethnology* / Q000401:mortality; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents