Racial disparities in post-transplant stroke and mortality following stroke in adult cardiac transplant recipients in the United States.
Racial disparities in post-transplant stroke and mortality following stroke in adult cardiac transplant recipients in the United States.
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DOI：
10.1371/journal.pone.0268275
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
黑人心脏移植受者在移植后6-12个月死亡率高于白人受者。在心脏移植受者中，移植后卒中发病率和全因死亡率是否存在种族差异尚不清楚。使用全国移植登记，我们使用逻辑回归评估种族与移植后卒中事件之间的关系，并使用Cox比例风险回归评估移植后卒中存活成人中种族与死亡率之间的关系。我们没有发现种族与移植后卒中发生率之间存在关联的证据（OR = 1.00, 95% CI: 0.83-1.20）。移植后卒中患者的中位生存时间为4.1年（95% CI: 3.0, 5.4）。1139例移植后中风患者中有726例死亡，其中203例黑人患者中有127例死亡，936例白人患者中有599例死亡。在移植后中风幸存者中，黑人移植受者的死亡率比白人受者高23% （HR = 1.23, 95% CI: 1.00-1.52）。这种差异在前6个月之后最为明显，似乎是由黑人和白人患者移植后护理环境的差异所介导的。在过去十年中，死亡率结果的种族差异并不明显。近十年来，黑人患者存活率的提高可能反映了不分种族的心脏移植受者的整体方案的改进，例如手术技术和术后即时护理的进步，以及对减少种族差异的认识的提高。
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. 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: 0.83–1.20). 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 23% higher rate of mortality compared to white recipients (HR = 1.23, 95% CI: 1.00–1.52). 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. 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.
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