Purpose
Children of minority race and ethnicity experience inferior outcomes postheart transplantation
(HTx). Studies have associated ventricular assist device (VAD) bridge-to-transplant
(BTT) with similar-to-superior post-transplant-survival (PTS) compared to no mechanical
circulatory support. It is unclear whether racial and ethnic discrepancies exist in
VAD utilization and outcomes.
Methods
The United Network for Organ Sharing (UNOS) database was used to identify 6,121 children
(<18 years) listed for HTx between 2006 and 2021: black (B—22% of cohort), Hispanic
(H—21%), and white (W—57%). VAD utilization, outcomes, and PTS were compared between
race/ethnicity groups. Multivariable Cox proportional analyses were used to study
the association of race and ethnicity on PTS with VAD BTT, using backward selection
for covariates.
Results
Black children were most ill at listing, with greater proportions of UNOS status 1A/1
(p < 0.001 vs H & W), severe functional limitation (p < 0.001 vs H & W), and greater inotrope requirements (p < 0.05 vs H). Non-white children had higher proportions of public insurance. VAD
utilization at listing was: B—11%, H—8%, W—8% (p = 0.001 for B vs H & W). VAD at transplant was: B—24%, H—21%, W—19% (p = 0.001 for B vs H). At transplant, all VAD patients had comparable clinical status
(functional limitation, renal/hepatic dysfunction, inotropes, mechanical ventilation;
all p > 0.05 between groups). Following VAD, hospital outcomes and one-year PTS were equivalent
but long-term PTS was significantly worse among non-whites-(p < 0.01 for W vs B & H). On multivariable analysis, black race independently predicted
mortality (hazard ratio 1.67 [95% confidence interval 1.22-2.28]) while white race
was protective (0.54 [0.40-0.74]).
Conclusions
Pediatric VAD use is, seemingly, equitable; the most ill patients receive the most
VADs. Despite similar pretransplant and early post-transplant benefits, non-white
children experience inferior overall PTS after VAD BTT.
Keywords
Abbreviations:
CHD (congenital heart disease), UNOS (United Network for Organ Sharing), VAD (ventricular assist device)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 27, 2022
Publication stage
In Press Journal Pre-ProofIdentification
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© 2022 International Society for Heart and Lung Transplantation. All rights reserved.
