Abstract 4957: Racial Differences in Waitlist Mortality in Children Listed for Heart Transplant in the United States in the Current Era
Disparities in access and utilization of solid organ transplantation in racial minorities are well known in adults but not children. We assessed racial differences in waitlist mortality in children listed for heart transplant (HT) in the United States (US) in the current era. Data from the United Network of Organ Sharing for all US children<18 years of age listed for primary HT during 1999 –2006 were analyzed. Clinical variables were defined at the time of listing. Race was defined as reported by HT centers. Multivariable Cox proportional hazards modeling was used to determine the relationship between race and waitlist mortality. Of 3299 listed children, 1913 (58%) were White, 657 (20%) were Black, 519 (16%) were Hispanic, 109 (3%) were Asian and the remaining 101 (3%) were defined as “Other”. The racial groups were similar with respect to distribution of listing status, percent patients on hemodynamic support and those with pre-formed antibodies >10%. Black and Hispanic children lived in areas with lower median household income ($33,352, $37,516, and $43,077 for Black, Hispanic and White children respectively, P<0.001) and were more likely to have Medicaid insurance compared to White children (58%, 59% and 24% respectively, P<0.001). Waitlist mortality was 14% for White, 19% for Black, 21% for Hispanic, 17% for Asian and 27% for “Other” children. After controlling for age, cardiac diagnosis, listing status, hemodyamic support and creatinine clearance, Black (hazard ratio HR 1.6, 95% confidence interval CI 1.3–1.9, P<0.001), Hispanic (HR 1.5, CI 1.2–1.9, P=0.001), Asian (HR, 2.1, CI 1.3–3.3, P=0.003) and “Other” children (HR 2.3, CI 1.5–3.4, P<0.001) were all at higher risk for waitlist mortality compared to White children. After adjusting additionally for insurance and area household income, the risk of death remained higher for all nonwhite races (HR 1.4 for Black, 1.4 for Hispanic, 2.3 for Asian and 2.2 for “Other” children, P<0.01 for all). Nonwhite children listed for heart transplant have higher waitlist mortality compared to White children after controlling for clinical risk factors. Socioeconomic variables explain only a small fraction of this increased risk.