Open AccessCardiac Transplantation in African Americans: A Single‐Center Experience
Author(s) -
Suryanarayana Prakash Goutham,
Copeland Hannah,
Friedman Mark,
Copeland Jack G.
Publication year - 2014
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22275
Subject(s) - medicine , proportional hazards model , heart transplantation , transplantation , survival analysis , creatinine , single center , stepwise regression , survival rate , gastroenterology , surgery
Background In view of limited data on the subject of graft and patient survival differences between African American ( AA ) and non‐ AA heart transplant recipients, we reviewed our experience.Hypothesis There is a higher mortality among AA recipients compared with non‐ AA recipients after cardiac transplantation.Methods The study included all AA patients who have received a heart transplant in our center since 1983. Stepwise Cox regression was used for covariates affecting the survival. The χ 2 test was employed to identify the effects of a mechanical assist device and pretransplant creatinine (Cr) on the outcomes in AA and non‐ AA patients. Kaplan‐Meier curves were used to examine survival.Results The average survival among AA recipients was 5.4 years, compared with 12 years for the non‐ AA recipients, with 1‐, 5‐, and 10‐year survival rates of 80%, 55%, and 25%, respectively. This was found to be statistically inferior to the survival probabilities of 92%, 78%, and 58% for the non‐ AA group ( P < 0.005). Based on stepwise Cox regression, the variables such as ethnicity ( P < 0.05), pretransplant Cr ( P < 0.05), presence of a mechanical assist device ( P < 0.005), and United Network for Organ Sharing ( UNOS ) status at transplant ( P < 0.05) independently predicted the outcomes. Kaplan‐Meier analysis of pretransplant Cr level and survival showed that the AA group did significantly worse for all Cr classes.Conclusions There is a statistically significant difference in outcomes between AA and non‐ AA patients after cardiac transplantation. African American patients have decreased survival over a period of time. Pretransplant Cr, ethnicity, presence of a mechanical assist device, and UNOS status at transplantation are independent predictors of outcomes.