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Donor-recipient race mismatch and graft survival after pediatric heart transplantation.
Ann Thorac Surg. 2009 Jan; 87(1):204-9; discussion 209-10.AT

Abstract

BACKGROUND

Black recipient race has been shown to predict poorer graft survival after pediatric heart transplantation. We analyzed our single-center experience comparing graft survival by race and the impact of donor-recipient race mismatch.

METHODS

One hundred sixty-nine consecutive primary pediatric heart transplant patients were analyzed by donor and recipient race (white recipient, 99; black recipient, 60; other, 10). The groups were similar in preoperative characteristics. There were fewer donor-recipient race matches in blacks compared with whites (10 versus 71; p < 0.0001).

RESULTS

Although 30-day and 6-month graft survival was similar for black and white recipients (93.9% and 85.8% versus 93.3% and 83.3%, respectively), overall actuarial graft survival was significantly lower in blacks (p < 0.019). Blacks tended to have a higher incidence of positive retrospective crossmatch (n = 26, 43%) than whites (n = 29, 29%), but this was not statistically significant (p = 0.053). The median graft survival for black recipients was 5.5 years compared with 11.6 years for whites. Donor-recipient race mismatch predicted poorer graft survival (5-year graft survival 48.9% versus 72.3%; p = 0.0032). The median graft survival for donor-recipient race-matched patients was more than twice that for mismatched patients (11.6 years versus 4.4 years). Cox proportional hazard analysis showed that donor-recipient race mismatch neutralized the effect of race on graft survival.

CONCLUSIONS

Graft survival after pediatric heart transplantation is inferior for black recipients compared with white recipients. These differences may be explained by a high incidence of donor-recipient race mismatch, which also predicts poorer outcome for all racial groups with pediatric heart transplantation. These data may have implications for future donor allocation schemes.

Authors+Show Affiliations

Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA. kkanter@emory.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19101298

Citation

Kanter, Kirk R., et al. "Donor-recipient Race Mismatch and Graft Survival After Pediatric Heart Transplantation." The Annals of Thoracic Surgery, vol. 87, no. 1, 2009, pp. 204-9; discussion 209-10.
Kanter KR, Berg AM, Mahle WT, et al. Donor-recipient race mismatch and graft survival after pediatric heart transplantation. Ann Thorac Surg. 2009;87(1):204-9; discussion 209-10.
Kanter, K. R., Berg, A. M., Mahle, W. T., Vincent, R. N., Kilgo, P. D., Kogon, B. E., & Kirshbom, P. M. (2009). Donor-recipient race mismatch and graft survival after pediatric heart transplantation. The Annals of Thoracic Surgery, 87(1), 204-9; discussion 209-10. https://doi.org/10.1016/j.athoracsur.2008.09.074
Kanter KR, et al. Donor-recipient Race Mismatch and Graft Survival After Pediatric Heart Transplantation. Ann Thorac Surg. 2009;87(1):204-9; discussion 209-10. PubMed PMID: 19101298.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Donor-recipient race mismatch and graft survival after pediatric heart transplantation. AU - Kanter,Kirk R, AU - Berg,Alexandria M, AU - Mahle,William T, AU - Vincent,Robert N, AU - Kilgo,Patrick D, AU - Kogon,Brian E, AU - Kirshbom,Paul M, PY - 2008/01/29/received PY - 2008/09/25/revised PY - 2008/09/29/accepted PY - 2008/12/23/entrez PY - 2008/12/23/pubmed PY - 2009/1/23/medline SP - 204-9; discussion 209-10 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 87 IS - 1 N2 - BACKGROUND: Black recipient race has been shown to predict poorer graft survival after pediatric heart transplantation. We analyzed our single-center experience comparing graft survival by race and the impact of donor-recipient race mismatch. METHODS: One hundred sixty-nine consecutive primary pediatric heart transplant patients were analyzed by donor and recipient race (white recipient, 99; black recipient, 60; other, 10). The groups were similar in preoperative characteristics. There were fewer donor-recipient race matches in blacks compared with whites (10 versus 71; p < 0.0001). RESULTS: Although 30-day and 6-month graft survival was similar for black and white recipients (93.9% and 85.8% versus 93.3% and 83.3%, respectively), overall actuarial graft survival was significantly lower in blacks (p < 0.019). Blacks tended to have a higher incidence of positive retrospective crossmatch (n = 26, 43%) than whites (n = 29, 29%), but this was not statistically significant (p = 0.053). The median graft survival for black recipients was 5.5 years compared with 11.6 years for whites. Donor-recipient race mismatch predicted poorer graft survival (5-year graft survival 48.9% versus 72.3%; p = 0.0032). The median graft survival for donor-recipient race-matched patients was more than twice that for mismatched patients (11.6 years versus 4.4 years). Cox proportional hazard analysis showed that donor-recipient race mismatch neutralized the effect of race on graft survival. CONCLUSIONS: Graft survival after pediatric heart transplantation is inferior for black recipients compared with white recipients. These differences may be explained by a high incidence of donor-recipient race mismatch, which also predicts poorer outcome for all racial groups with pediatric heart transplantation. These data may have implications for future donor allocation schemes. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/19101298/Donor_recipient_race_mismatch_and_graft_survival_after_pediatric_heart_transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(08)02070-5 DB - PRIME DP - Unbound Medicine ER -