ATS: Insurance & education, not race matching, better predict heart transplant problems
Race-matched donor hearts do not lead to better outcomes after heart transplantation. Instead, the type of insurance plan and education levels could indicate worse outcomes among racial and ethnic groups, according to a study published online June 1 in the Annals of Thoracic Surgery.
Researchers from Johns Hopkins Hospital in Baltimore reviewed medical records of 20,185 heart patients who received transplants between 1997 and 2007 at 140 hospital sites to assess outcomes in race-matched donor hearts transplanted into the same ethnic/racial groups.
Jeremiah Allen, MD, and colleagues found that 61 percent of the 20,185 transplant patients were race matched.
According to the results, the death rate after transplant for blacks was 35 percent whether transplant hearts were race matched or not. These same numbers for whites and Hispanics who had race matched hearts were 26 and 28 percent, respectively.
"It does not matter whether a white, black, Hispanic or Asian donor heart is transplanted into a patient of any other particular race," said Ashish Shah, MD, the study’s senior investigator. "Other factors must be the reason for any differences in how well people do after transplantation, in particular, why blacks have poorer outcomes."
The researchers found that no matter whether or not blacks had a transplant that was race matched their chance of mortality after transplant was still 46 percent higher than the other patient groups after 10 years.
Ten years after transplant, 45.8 percent of blacks were alive after the procedure—this was 11.4 percent lower than whites and 10.8 percent lower than Hispanic patients.
"This problem is not just about biology or race, it is also about the health system that supports our patients," said Shah. “This really prompts us to re-evaluate everything that we do for our more vulnerable patients and to tailor our efforts to the specific needs of each patient, especially African Americans, if we hope to fix racial disparities in surviving heart transplantation.”
The results showed that patients on Medicaid had a 30 percent greater chance of needing an anti-rejection treatment and 39 percent greater chance of dying than patients with private insurance.
Additionally, patients on Medicare had a 12 percent higher risk of death than those with private insurance.
According to the researchers, 20.5 percent of black heart transplant patients were on Medicaid compared to 8.8 percent of other races and 49.9 percent held private insurance, versus 63.6 percent of the other racial/ethnic groups.
The results also showed that patients who attended college had a 12 percent less likely chance of having a rejection-related problem after transplant than those who did not.
Overall, African Americans attended college less than the other races, 40.6 percent compared to 50.3 percent.
Lastly, researchers found that blacks had a higher degree of tissue antigen mismatches compared with the other patient cohorts, 65.4 and 55.6 percent, respectively. Allen et al said that immunosuppressive drugs work better to prevent organ rejection in better matched transplant hearts.
According to Shah, studying antirejection drug dosages, better patient follow-up and better post-follow-up education about infection and organ rejection signs are needed to increase outcomes and survival rates, particularly among blacks who represent 15 percent of all heart transplants.
Researchers from Johns Hopkins Hospital in Baltimore reviewed medical records of 20,185 heart patients who received transplants between 1997 and 2007 at 140 hospital sites to assess outcomes in race-matched donor hearts transplanted into the same ethnic/racial groups.
Jeremiah Allen, MD, and colleagues found that 61 percent of the 20,185 transplant patients were race matched.
According to the results, the death rate after transplant for blacks was 35 percent whether transplant hearts were race matched or not. These same numbers for whites and Hispanics who had race matched hearts were 26 and 28 percent, respectively.
"It does not matter whether a white, black, Hispanic or Asian donor heart is transplanted into a patient of any other particular race," said Ashish Shah, MD, the study’s senior investigator. "Other factors must be the reason for any differences in how well people do after transplantation, in particular, why blacks have poorer outcomes."
The researchers found that no matter whether or not blacks had a transplant that was race matched their chance of mortality after transplant was still 46 percent higher than the other patient groups after 10 years.
Ten years after transplant, 45.8 percent of blacks were alive after the procedure—this was 11.4 percent lower than whites and 10.8 percent lower than Hispanic patients.
"This problem is not just about biology or race, it is also about the health system that supports our patients," said Shah. “This really prompts us to re-evaluate everything that we do for our more vulnerable patients and to tailor our efforts to the specific needs of each patient, especially African Americans, if we hope to fix racial disparities in surviving heart transplantation.”
The results showed that patients on Medicaid had a 30 percent greater chance of needing an anti-rejection treatment and 39 percent greater chance of dying than patients with private insurance.
Additionally, patients on Medicare had a 12 percent higher risk of death than those with private insurance.
According to the researchers, 20.5 percent of black heart transplant patients were on Medicaid compared to 8.8 percent of other races and 49.9 percent held private insurance, versus 63.6 percent of the other racial/ethnic groups.
The results also showed that patients who attended college had a 12 percent less likely chance of having a rejection-related problem after transplant than those who did not.
Overall, African Americans attended college less than the other races, 40.6 percent compared to 50.3 percent.
Lastly, researchers found that blacks had a higher degree of tissue antigen mismatches compared with the other patient cohorts, 65.4 and 55.6 percent, respectively. Allen et al said that immunosuppressive drugs work better to prevent organ rejection in better matched transplant hearts.
According to Shah, studying antirejection drug dosages, better patient follow-up and better post-follow-up education about infection and organ rejection signs are needed to increase outcomes and survival rates, particularly among blacks who represent 15 percent of all heart transplants.