: Older studies demonstrated that children in the U.S. from racial and ethnic minorities have inferior waitlist and post-heart transplant (HT) outcomes. Whether these disparities still exist in the contemporary era of increased ventricular assist device utilization remains unknown.

: All children (age <18 years) in the SRTR database listed for HT from December 2011 to February 2019 were included and separated into 5 race/ethnicities: Caucasian, African American, Hispanic, Asian and Other. Differences in clinical characteristics and survival amongst children of different racial/ethnic groups were compared at listing and at HT.

: The waitlist cohort consisted of 2134 (52.2%) Caucasian, 840 (20.5%) African American, 808 (19.8%) Hispanic, 161 (3.9%) Asian, and 146 children of Other races (3.6%). At listing, Asian children mostly had cardiomyopathy (70.8%) while Caucasian children had congenital heart disease (58.7%). African American children were most likely to be listed Status 1A, have renal dysfunction and hypoalbuminemia at listing. African American and Hispanic children were most likely to be on Medicaid. On multivariable analysis, only African American children were at increased risk for waitlist mortality compared to Caucasian children (aHR = 1.25; p = 0.029). Post-HT, there were no disparities in early and mid-term graft survival among groups, however, African American children had increased number of rejection episodes compared to Caucasian and Hispanic children.

: African American children continue to experience increased waitlist mortality and have increased rejection episodes post-HT. Studies exploring barriers to healthcare access and implicit bias as reasons for these disparities need to be explored.