Cardiac transplantation in African Americans: a single-center experience

The status of diversity in the heart transplant workforce

Cardiac surgery and cardiology consistently have the lowest representation of women and racial minorities among all the specialties. The poor representation of minorities and women in cardiology and cardiac surgery is compounded by the fact that heart failure risk continues to rise in the United States (US) and disproportionately affects non-white patients. Inclusion in academia is imperative in diversifying the workforce and in turn, in improving the care we provide to all of our patients.

The effects of increased donor support time from organ donation referral to donor procurement on heart transplant recipient survival

INTRODUCTION

Given the known deleterious cardiac effects of brain death (BD) physiology, we hypothesized that time from cardiac donation referral to procurement (donor support time [DST]), would negatively impact cardiac transplant recipient survival.

METHODS

The United Network for Organ Sharing database was queried from 2007 to 2018, identifying 22,593 donor hearts for analysis. Multivariate logistic models for 30-day and 1-year survival, as well as Cox models for overall survival and posttransplant rejection, were used to assess adjusted outcomes.

RESULTS

median DST was 3 days (interquartile range: 2-5 days). Ischemic time; distance between donor and recipient hospitals; and recipient age, creatinine, waitlist time, and length of stay were adjusted predictors of survival and rejection. DST was not associated with either outcome in aggregate; however, differential association by donor race was identified, with DST in any race recipient associated with 4% higher odds of 1-year mortality (p = .001; p value for interaction .005) but only a trend towards worse overall mortality (p = .064; p value for interaction .046).

CONCLUSION

Thus, duration of exposure to BD physiology may have a differential impact on recipient outcomes based on donor race, suggesting that additional research is needed on donor immunologic, socioeconomic, and healthcare access factors that may impact cardiac transplant recipient outcomes.

Looking at cardiac transplantation through a 20-year retrospective study-invited commentary

The authors present an excellent large cohort review and complete analysis of long-term heart transplant survival including multiple institutions. Most studies on long-term heart transplant survival have single-center institutional experience. The authors present a comprehensive national review of the United Network for Organ Sharing Database (UNOS). The paper reflects the early transplant era through 1998 and demonstrates the long-term survival of this time.

Sex differences in preformed panel-reactive antibody levels and outcomes in patients undergoing heart transplantation

BACKGROUND

Sex differences in panel-reactive antibody (PRA) levels in heart transplant recipients and their association with transplant-related outcomes are mostly unknown.

METHODS

In 20 181 (24.7% women) first-time heart transplant recipients included from July 2004 to March 2015 in the prospective Organ Procurement and Transplantation Network (OPTN), we studied sex differences in most recent (mr) and peak (p)PRA and outcomes (graft failure, rejection, cardiac allograft vasculopathy [CAV], retransplantation, and mortality). Median follow-up (all-cause mortality) was 6 years. Analyses are based on OPTN data (March 6, 2017).

RESULTS

MrPRA levels were associated with all-cause mortality (hazard ratio, 95% confidence interval: class I 1.03, 1.01-1.04, P < 0.001) and acute rejection (class II 1.08, 1.03-1.14, P = 0.0044). PPRA levels were associated with all-cause mortality (class I 1.02, 1.00-1.04, P = 0.015) and CAV (class II 1.03, 1.01-1.06, P = 0.020). Sex interactions were seen for the association of pPRA and graft failure with a higher risk in women, and for pPRA and CAV with a higher risk in men.

CONCLUSIONS

PRA were associated with different transplant-related outcomes in both sexes. However, women with elevated pPRA were shown to be at higher risk for graft failure, whereas higher levels of pPRA were more hazardous for men in developing CAV.

Mortality, rehospitalization, and post-transplant complications in gender-mismatched heart transplant recipients

BACKGROUND

Limited research has been published on outcomes in heart transplant (HT) recipients with gender-mismatched donors.

OBJECTIVE

Compare 3-year post-transplant outcomes in 2 groups of gender-mismatched HT recipients and a no-mismatch group.

METHODS

Sample: 347 HT recipients: 21.3% (74) received a heart from the opposite gender: Group 1: same gender donor/recipient (273, 78.7%); Group 2: female donor/male recipient (40, 11.5%); Group 3: male donor/female recipient (34, 9.8%).

OUTCOMES

mortality, hospitalization, and complications.

RESULTS

Female patients with male heart donors had shorter 3-year survival, were rehospitalized more days after HT discharge, and had more treated acute rejection episodes and cardiac allograft vasculopathy. No differences were found in: HT length of stay, respiratory failure, stroke, cancer, renal dysfunction, steroid-induced diabetes, number of IV-treated infections, or the timing of infection and rejection.

CONCLUSION

Female HT recipients with male donors had worse 3-year outcomes as compared to male-mismatch and no-mismatch groups.