Racial disparity exists in the utilization and post-transplant survival benefit of ventricular assist device support in children

被引:1
作者
Greenberg, Jason W. [1 ,4 ]
Bryant, Roosevelt [2 ]
Villa, Chet [1 ]
Fields, Katrina [1 ]
Fynn-Thompson, Francis [3 ]
Zafar, Farhan [1 ]
Morales, David L. S. [1 ]
机构
[1] Univ Cincinnati, Cincinnati Childrens Hosp Med Ctr, Coll Med, Heart Inst, Cincinnati, OH USA
[2] Phoenix Childrens Hosp, Div Cardiothorac Surg, Phoenix, AZ USA
[3] Boston Childrens Hosp, Dept Cardiac Surg, Boston, MA USA
[4] Univ Cincinnati, Cinmati Childrens Hosp Med Ctr, Coll Med, Heart Inst, 3333 Burnet AVe, Cincinnati, OH 45229 USA
关键词
Congenital heart disease; Mechanical circulatory support; Pediatric heart transplantation; Racial disparities; Ventricular assist device; PEDIATRIC HEART-TRANSPLANT; MECHANICAL CIRCULATORY SUPPORT; OUTCOMES; MORTALITY; SOCIETY; BLACK; MODEL; ERA;
D O I
10.1016/j.healun.2022.12.020
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 nonwhites-(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 (c) 2022 International Society for Heart and Lung Transplantation. All rights reserved.
引用
收藏
页码:585 / 592
页数:8
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