ABSTRACT

Background Black heart transplant recipients have a higher mortality rate than white recipients 6-12 months after transplant. Whether there are racial disparities in post-transplant stroke incidence and all-cause mortality following post-transplant stroke among cardiac transplant recipients is unknown.

Methods and Findings Using a nationwide transplant registry, we assessed the association between race and incident post-transplant stroke using logistic regression and the association between race and mortality among adults who survived a post-transplant stroke using Cox proportional hazards regression. We found no evidence of an association between race and the odds of post-transplant stroke (OR = 1.00, 95% CI: 0.83 – 1.21). The median survival time of those with a post-transplant stroke in this cohort was 4.1 years (95% CI: 3.0, 5.4). There were 726 deaths among the 1139 patients with post-transplant stroke, including 127 deaths among 203 Black patients and 599 deaths among 936 white patients. Among post-transplant stroke survivors, Black transplant recipients experienced a 27% higher rate of mortality compared to white recipients (HR = 1.27, 95% CI: 1.03 – 1.57). This disparity is strongest in the period beyond the first 6 months and appears to be mediated by differences in the post-transplant setting of care between Black and white patients. The racial disparity in mortality outcomes was not evident in the past decade.

Conclusions The improved survival of Black patients in the recent decade may reflect overall protocol improvements for heart transplant recipients irrespective of race, such as advancements in surgical techniques and immediate postoperative care as well as increased awareness about reducing racial disparities.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

EM is funded by Grant # K01AA027831 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was reviewed and approved by the Institutional Review Board at Harvard T.H. Chan School of Public Health.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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Footnotes

liou.lathangmail.com

elm225mail.harvard.edu

Laura.Lehmanchildrens.harvard.edu

soziemasaliahsph.harvard.edu

suruchiguptahsph.harvard.edu

fbarrerafloreshsph.harvard.edu

Authorship Lathan Liou designed the study, performed the data analysis, and wrote the manuscript. EM and MAM helped design the study and edit the manuscript. Laura Lehman, SS, SG, and FJB helped edit the manuscript.

Disclosure The authors declare no conflicts of interest.

Funding Elizabeth Mostofsky is funded by Grant # K01AA027831 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations.

Data Availability Statement: Data is available by request from the SRTR.

Data Availability

Data is available by request from the SRTR.

AbbreviationsORodds ratioHRhazards ratioCIconfidence intervalSRTRScientific Registry of Transplant RecipientsOPTNOrgan Procurement and Transplantation NetworkBMIbody mass indexVADventricular assist deviceECMOextracorporeal membrane oxygenationICUintensive care unit