The Impact of Race on Survival After Heart Transplantation: An Analysis of More Than 20,000 Patients
The Impact of Race on Survival After Heart Transplantation: An Analysis of More Than 20,000 Patients
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DOI：
10.1016/j.athoracsur.2010.02.093
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发表时间：
2010-06-01
影响因子：
4.6
通讯作者：
Shah, Ashish S.
中科院分区：
文献类型：
--
作者：
Allen, Jeremiah G.;Weiss, Eric S.;Shah, Ashish S.
背景有证据表明，同种异体原位心脏移植（OHT）后的存活率存在种族相关差异。器官共享联合网络数据库提供了一个机会，在一个大型队列的成人OHT患者的结果检查种族的影响。我们回顾性分析了器官共享联合网络（United Network for Organ Sharing）中20,185例接受原发性OHT的成人患者的数据（1997年至2007年）。患者被分成特定种族的组，并根据供体和受体种族匹配进行分层。采用多变量考克斯比例风险回归分析，包括23个变量和供体和受体种族之间的相互作用项，研究种族对死亡率的影响。研究了第一年的死亡率（30天、90天、1年、2年和5年）和排斥反应。使用Kaplan-Meier方法对OHT后累积生存率进行建模。在20，185例患者中，12，381例（61%）为人种匹配（75%白人，n = 11，456; 17%非洲裔美国人，n = 514; 30%西班牙裔，n = 391; 5%亚洲人，n = 19）。5614例患者（28%）在研究期间死亡。与白人相比，非洲裔美国人的10年生存率绝对下降了11.4%。风险调整后，非裔美国人接受者的累积死亡风险增加了46%（风险比，1.46; 95%置信区间，1.24至1.72; p < 0.001）。非裔美国人接受者的生存率下降并没有改善种族匹配的OHT，也没有种族匹配的任何种族亚组的生存优势。在第一年剔除死亡后，非裔美国受者的生存率持续下降。我们的研究代表了评估成人OHT种族的最大现代队列。非裔美国人接受OHT后的生存率明显更差。种族匹配并没有提高生存率。(Ann Thorac Surg 2010; 89：1956-64）（C）2010年，胸外科医师协会
Background. Evidence exists for race-linked discrepancies in survival after orthotopic heart transplantation (OHT). The United Network for Organ Sharing database provides an opportunity to examine the effect of race on outcomes in a large cohort of adult OHT patients.Methods. We retrospectively reviewed the United Network for Organ Sharing data for 20,185 adult patients receiving primary OHT (1997 through 2007). Patients were divided into groups of specific race and also stratified by donor and recipient race-matching. The impact of race on mortality was examined using multivariable Cox proportional hazard regression analysis incorporating 23 variables and interaction terms between donor and recipient race. Mortality (30 days, 90 days, 1 year, 2 years, and 5 years) and rejection in the first year were examined. Cumulative post-OHT survival was modeled using the Kaplan-Meier method.Results. Of 20,185 patients, 12,381 (61%) were race matched (75% of whites, n = 11,456; 17% of African Americans, n = 514; 30% of Hispanics, n = 391; 5% of Asians, n = 19). Five thousand six hundred fourteen patients (28%) died during the study. African American recipients have an 11.4% absolute decrease in 10-year survival compared with whites. After risk adjustment, African American recipients have a 46% increase in the risk of cumulative mortality (hazard ratio, 1.46; 95% confidence interval, 1.24 to 1.72; p < 0.001). Decreased survival in African American recipients was not improved with race-matched OHT, nor was there a survival advantage with race-matching in any racial subgroup. Decreased survival in African American recipients persisted after censoring deaths in the first year.Conclusions. Our study represents the largest modern cohort evaluating race in adult OHT. African American recipients have significantly worse survival after OHT. Race-matching did not confer improved survival. (Ann Thorac Surg 2010; 89: 1956-64) (C) 2010 by The Society of Thoracic Surgeons