Background
Reducing racial disparities in lung transplant outcomes is a current priority of providers,
policymakers, and lung transplant centers. It is unknown how the combined effect of
race and ethnicity, gender, and diagnosis group is associated with differences in
1-year mortality and 5-year survival.
Methods
This is a longitudinal cohort study using Standard Transplant Analysis Research files
from the United Network for organ sharing. A total of 25,444 patients undergoing first
time lung transplantation between 2006 and 2019 in the United States. The primary
exposures were lung transplant recipient race and ethnicity, gender, and primary diagnosis
group at listing. Multivariable regression models and cox-proportional hazards models
were used to determine adjusted 1-year mortality and 5-year survival.
Results
Overall, 25,444 lung transplant patients were included in the cohort including 15,160
(59.6%) men, 21,345 (83.9%) White, 2,318 (9.1%), Black and Hispanic/Latino (7.0%).
Overall, men had a significant higher 1-year mortality than women (11.87%; 95% CI
11.07-12.67 vs 12.82%; 95% CI 12.20%-13.44%). Black women had the highest mortality
of all race and gender combinations (14.51%; 95% CI 12.15%-16.87%). Black patients
with pulmonary vascular disease had the highest 1-year mortality (19.77%; 95% CI 12.46%-27.08%)
while Hispanic/Latino patients with obstructive lung disease had the lowest (7.42%;
95% CI 2.8%-12.05%). 5-year adjusted survival was highest among Hispanic/Latino patients
(62.32%) compared to Black (57.59%) and White patients (57.82%).
Conclusions
There are significant differences in 1-year and 5-year mortality between and within
racial and ethnic groups depending on gender and primary diagnosis. This demonstrates
the impact of social and clinical factors on lung transplant outcomes.
Keywords
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Publication history
Published online: March 01, 2023
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