Academic research has produced conflicting reports on whether heart transplant patients have better survival and less frequent organ rejection if the transplanted heart comes from a donor of the same race.
But a new study from Johns Hopkins Medicine puts the issue to rest. In a review of 20,185 heart transplant patients who had surgery at 140 hospitals, researchers found that recipients of organs from donors with the same racial background did no better or worse than those who received organs from donors of different races.
"It does not matter whether a white, black, Hispanic, or Asian donor heart is transplanted into a patient of any particular race," says senior investigator and Johns Hopkins transplant surgeon, Ashish Shah, MD. "Other factors must be the reason for any differences in how well people do after transplantation, in particular, why blacks have poorer outcomes."
The report is published today in the Annals of Thoracic Surgery.
The researchers say their report is the largest and most detailed review of medical records ever conducted on the subject. All transplant recipients received a donor heart between 1997 and 2007.
Shah said flaws in the healthcare system, the type of insurance and education levels as well as biological factors likely have more to do with why blacks have disproportionately worse outcomes after heart transplants than whites.
According to their study, blacks had the same death rate, 35%, within five years regardless of whether recipients were race-matched with their donors or not. Likewise, the death rate for whites was the same at 26%, and Hispanics, 28%.
For Asians, there was a difference but researchers said that the number of heart transplants in this racial group was not statistically large enough for validity.
The data "really prompts us to re-evaluate everything that we do for our more vulnerable patients and to tailor our efforts to the specific needs of each patient, especially African Americans, if we hope to fix racial disparities in surviving heart transplantation."
African Americans represent 15% of all heart transplants, so lifting survival rates for this group should focus on anti-rejection drugs and dosages, regimens and scheduled appointments, and education about early signs of infection and organ rejection.
One finding that did stand out was that black recipients had a higher degree of tissue antigen mismatches with their transplanted hearts, 65.4% compared with other groups, which had 55.6%. The better the match the better chance immunosuppressive drugs will prevent organ rejection over the long term.
The researchers also discovered that insurance and education seemed to be linked to different rates of organ rejection within the first year. Patients with public insurance, specifically Medicaid, had a 30% higher risk of needing anti-rejection treatment and a 39% higher risk of dying than transplant recipients with private insurance.
Likewise for transplant recipients on Medicare, who had a 12% higher risk of dying than those with private insurance. Having a college education lowered the overall group’s likelihood of having a rejection-related problem with their transplant by 12%.
The project used statistics collected from the United Network for Organ Sharing, the agency that allocates donated organs across the U.S. It was funded by Johns Hopkins Hospital and the U.S. Department of Health and Human Services and the Health Resources and Services Administration.