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Original Articles: Pediatric Cardiac

Donor–Recipient Race Mismatch and Graft Survival After Pediatric Heart Transplantation

^a Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
^b Emory University School of Medicine, Atlanta, Georgia
^c Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia

Accepted for publication September 29, 2008.

^_* Address correspondence to Dr Kanter, Pediatric Cardiac Surgery, Emory University School of Medicine, 1405 Clifton Rd, Atlanta, GA 30322 (Email: kkanter{at}emory.edu).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

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.