In fact, Black patients in the 18–30 age bracket are twice as likely to die in the first year after their transplant, and 1.5 times as likely to die five years post-transplant, according to the paper, which was published February 2021 in the journal Circulation: Heart Failure. “We wanted to get a clearer picture on exactly where the health disparities are that account for worse outcomes in heart transplants and cardiovascular health,” says Hasina Maredia, MD, an internist at Massachusetts General Hospital in Boston and the lead author of the study. To conduct the study, Dr. Maredia and a team of researchers at Johns Hopkins University in Baltimore waded through data from the Scientific Registry of Transplant Recipients to analyze nearly 23,000 adults who received a heart transplant over a 12-year period. The team of doctors and statisticians then assigned the people in the study to four different age groups. They found that while Black recipients overall were at a 30 percent higher risk of death, the differences evened out with increasing age. In the group of 18- to 30-year-olds, the risk of death for Black recipients was 2.3 times higher in the first year post-transplant. “The first-year post-transplant is extremely high-risk because the body is reacting to the donor organ. This data is showing us that we need to zero in on those younger recipients to figure out what’s happening in their life and in their surroundings that may be contributing to poorer outcomes,” says Maredia. RELATED: A List of Events to Celebrate Black History Month Maredia and her colleagues broke down the data to pinpoint what disparities could be leading to poorer outcomes. They found that the young Black heart transplant recipients were far more likely to be on Medicaid instead of private insurance, were more likely to have a comorbidity like diabetes or hypertension, and were more likely to have a weakened heart muscle. “When financial and insurance resources are limited, that can be really hard on a patient,” says Errol L. Bush, MD, the senior author of the study, an associate professor of surgery, and the surgical director of the advanced lung disease and lung transplant program at Johns Hopkins University. Dr. Bush noted that the regimen of immunosuppressant drugs needed to prevent organ rejection, coupled with many follow-up appointments in the first year can be difficult to manage and prohibitively expensive. “It requires continued healthcare access and financial resources just to maintain the prescribed course,” says Bush. “It’s rigorous and expensive, and filling prescriptions and getting to appointments is extremely difficult to keep up with if someone loses their financial resources.” Bush would like to see more resources targeted to education so young Black recipients have a better understanding of the physical and emotional resources needed to succeed through the complex regimen of medicines and appointments required post-transplant. Additionally, Bush stressed that it is difficult to manage post-surgery recovery alone; it requires a network of caretakers and supporters who can help heart transplant recipients with transportation to and from appointments and the pharmacy. “This burden of care is just one of the systemic issues leading to these healthcare disparities,” says Bush. “We need clinicians and policymakers to come together and accept that there is a problem, discuss the issues, and find solutions.” Maredia added that systemic problems may prevent Black patients from living near well-resourced hospitals that have robust experience with heart transplants and the ability to dedicate time to patient education and post-surgery surveillance. “The authors should be commended,” says Maria Costanzo, MD, the medical director at Advocate Medical Group-Midwest Heart Specialists outside Chicago, who was not involved in the study. “We always say Black recipients have poorer outcomes, but these doctors dug into the data and have shown this doesn’t apply to the general population, but mostly to the younger population and in the first year. “We should view this as an invitation to do more,” Dr. Costanzo continues. “Not doing anything is not acceptable. In the U.S., 22 percent of organ recipients are Black, which means we have nearly one-fourth of our recipients at risk for worse outcomes. That’s a huge problem that needs to be addressed and corrected immediately.” RELATED: COVID-19 Magnifies Health Disparities Impacting Black Americans
