Cardiac transplantation in African Americans: A single-center experience

Prakash Goutham Suryanarayana, Hannah Copeland, Mark J Friedman, Jack G. Copeland

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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 χ2 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.

Original languageEnglish (US)
Pages (from-to)331-336
Number of pages6
JournalClinical Cardiology
Volume37
Issue number6
DOIs
StatePublished - 2014

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Heart Transplantation
African Americans
Creatinine
Survival
Equipment and Supplies
Transplants
Kaplan-Meier Estimate
Graft Survival
Survival Rate
Transplantation
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac transplantation in African Americans : A single-center experience. / Suryanarayana, Prakash Goutham; Copeland, Hannah; Friedman, Mark J; Copeland, Jack G.

In: Clinical Cardiology, Vol. 37, No. 6, 2014, p. 331-336.

Research output: Contribution to journalArticle

Suryanarayana, Prakash Goutham ; Copeland, Hannah ; Friedman, Mark J ; Copeland, Jack G. / Cardiac transplantation in African Americans : A single-center experience. In: Clinical Cardiology. 2014 ; Vol. 37, No. 6. pp. 331-336.
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abstract = "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 χ2 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.",
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N2 - 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 χ2 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.

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