Abstract 15480: Racial Differences in Heart Transplant Recipients Bridged with LVAD Support
Background: Racial differences in long-term outcomes after heart transplant are well known. However, racial differences in outcomes among those bridged with LVAD support have not been characterized. We sought to examine the differences in mortality in this population.
Methods: 3011 HT recipients bridged with LVAD support (exclusions included age < 18y & multiorgan transplant) were identified from UNOS (2005-2011) & stratified by race (white (W) vs non-white (NW)). Survival was censored at 5y. Multivariate Cox proportional hazard regression analysis was adjusted for age, sex, DM, ischemic time, dialysis, life support, wait time & HLA mismatch.
Results: There were 3011 patients of which 31.9% were non-white. Ischemic cardiomyopathy (48% & 25%, W & NW respectively) and dilated cardiomyopathies (45% & 69%, W & NW respectively) were the most prevalent diagnoses. There were more women in the NW group. In addition, the NW group was associated with higher mean PAP, higher PCWP and higher cardiovascular mortality. Survival (1, 3, 5y) was: white (89, 82, 74%) & non-white (85, 76, 70%) (Figure 1, log rank p=0.006). Unadjusted HR for all-cause mortality was 1.29 (CI 1.07-1.55, p < 0.0001). Multivariate analysis yielded a HR 1.34 (CI 1.09-1.65, p < 0.0001).
Conclusion: Survival of NW heart transplant recipients bridged with LVAD support was diminished compared to W patients in this cohort. This was associated with higher filling pressures and cardiovascular mortality. In addition, LVAD utilization between groups remained unchanged during the study period. Further study is warranted to understand and diminish the disparities in these groups.
- © 2012 by American Heart Association, Inc.