Racial Disparities in Patients Bridged to Heart Transplantation with Left Ventricular Assist Devices

Abstract Background Left ventricular assist devices (LVADs) are an effective therapy in bridging patients with end stage heart failure to heart transplantation. The aim of this study was to identify the role of race in survival of patients bridged to heart transplant with a LVAD. Methods The United Network of Organ Sharing (UNOS) database was queried for all adult heart transplant recipients (age>=18) who were bridged to transplantation with a LVAD from 2005 to 2018. Patients were stratified based on their race, with Caucasians as the reference group. Demographics, five-year survival and post-transplant graft failure were assessed with chi-square test, ANOVA, Kaplan-Meier survival analyses, log-rank tests and cox proportional hazards modeling or logistic regression modeling as appropriate. Results 6476 patients successfully bridged with a LVAD to heart transplantation were identified. There were 4263 Caucasians, 1536 African Americans, 508 Hispanics, and 169 Asians. Compared to Caucasians, African Americans had higher BMIs, were more likely to be female, pay with private insurance, and be working for income at the time of transplant. African Americans were found to have increased odds of graft failure (OR 1.27, p=0.048) compared to Caucasians. Additionally, African Americans were found to have increased risk of mortality at 5 years (HR 1.26, p=0.003). Conclusions African American race is associated with increased rates of post-transplantation graft failure and decreased five-year survival compared to Caucasian race. Given these findings, directed clinical attention may be warranted in African American patients bridged to heart transplantation with a LVAD.