African American (AA) race is associated with worse survival among heart transplant recipients. Even after controlling for socioeconomic and clinical characteristics, racial disparities persist and remain unexplained in the literature. Given survival and age are correlated, we examine whether the association of race and post-transplant mortality varies by age in order to identify and improve the management of patients with the highest risk of mortality.

METHODS: Using SRTR, we studied 29,039 adult heart transplant recipients from 1/1/2000-3/3/2016, comparing post-transplant survival in African-American (AA) vs non-AA recipients stratified by age (18-30, 31-40, 41-60 and 61-80). Cox regression was used to compare differences in the association of mortality and race by age after adjusting for recipient and donor characteristics.

RESULTS: AA recipients were older at transplantation than non-AA recipients, with median age of (IQR) 56 (48-62) vs 51 (40-58) (p<0.001). On average, AA recipients had a 17% higher risk of death than comparable non-AA candidates (adjusted HR=1.17, p=0.003). However, the association between AA race and mortality was amplified among younger recipients (Figure; p<0.001 for race/age interaction). Among recipients aged 18-30, AA had a 2.03-fold higher risk of death relative to non-AA recipients (p<0.05); however, among recipients aged 61-80, AA recipients had only a 1.22-fold higher risk (p<0.05) (Table).

CONCLUSIONS: Young AA recipients aged 18–30 years have the highest risk of death post-transplant relative to other age and race groups. Identifying that age modifies the association of race and mortality will provide better prognostication for transplant candidates and inform improved surveillance of young AA transplant recipients. Further investigation into reasons for reduced survival among young AA recipients is warranted in order to identify opportunities for more effective clinical management and for the reduction of racial disparities.

CITATION INFORMATION: Maredia H, Bowring M, Massie A, Oyetunji S, Merlo C, Higgins R, Segev D, Bush E. Young African American Heart Transplant Recipients Have an Elevated Risk of Post-Transplant Mortality. Am J Transplant. 2017;17 (suppl 3).

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