my personal edition > organ transplantation > news


  E-Mail this DGDispatch to a colleague

DGDispatch

African Americans Have Poorer Survival After Paediatric Heart Transplants Than Whites: Presented at STS

By Ed Susman

FORT LAUDERDALE, FL -- January 31, 2008 -- A study of paediatric cardiac transplantation outcomes indicates that African Americans fare poorly compared with whites in the long-term, but researchers say the difference in outcomes may be due to problems in finding matched hearts rather than a racial difference.

"Blacks have decreased graft survival after paediatric heart transplantation," said Kirk Kanter, MD, Professor of Surgery, Emory University School of Medicine, Atlanta, Georgia, United States. "But donor/recipient race mismatch is a more powerful predictor of poor outcome [than race]."

The problem, Dr. Kanter said, has a lot to do with the fact that while 36% of the patients undergoing paediatric cardiac transplantation at Emory were African American, 18% of the donor hearts came from African American donors, making a good match more difficult.

In an oral presentation here at the Society of Thoracic Surgeons 44th Annual Meeting. Dr. Kanter said, "We need to encourage donor awareness in blacks." The mismatch problem is exacerbated for African Americans, he noted, because there is greater heterogeneity among human leukocyte antigens (HLA) in African Americans, making an HLA match even more difficult.

Between 1988 and 2008, Emory paediatric heart doctors performed 201 transplants. For the study reported at STS, the transplants of 3 persons over the age of 18 and 29 retransplants were excluded, leaving 169 primary paediatric heart transplants.

Dr. Kanter said 99 of these transplants were performed on white children, 60 on African Americans, and 10 on other ethnicities. He said that 121 whites donated their hearts in this series, as well as 30 blacks, and 18 other ethnicities. There were no significant differences between the groups in terms of age, congenital diagnosis, prior operations, status in the United Network for Organ Sharing, or in the number of days on the heart transplant waiting list.

However, 72 of the white children received HLA matched organs compared with 17 of the African American children and none of the other ethnicities. The difference between whites and the other races for HLA matching was significant (P =.0001). About 50% of the white children survived 10 years compared with 30% of the African American children (P =.056).

Dr. Kanter noted that the 30-day survival and the 6-month survival for all three groups were not significantly different. One-month survival ranged from 90% to 93.9%; 6-month survival ranged from 83.3% to 90%. But then the gap between whites and African Americans widened. Median graft survival for whites was 11.6 years but just 5.5 years for African Americans (P=.019)

The researchers found a 2.3 times greater risk of transplant failure if there was an HLA mismatch, whether that mismatch occurred in whites or in blacks. In fact, the multivariate analysis shows that the difference between African Americans and whites was not significant (P =.2673). When white mismatched patients were compared with black mismatched patients, the survival curves were superimposable and significance was not approached (P =.69), Dr. Kanter said.

He noted that white children with matched HLA had a 55% survival after 10 years, but whites who had mismatched HLA hearts had about a 37% survival after 10 years (P =.064), further indicating that it was HLA matching that made the difference in outcome, not race.


[Presentation title: Impact of Race on Graft Survival after Paediatric Heart Transplantation. Abstract 4]

E-Mail this DGDispatch to a colleague

To print, use this version