Clin Transplant 1996 Dec;10(6 Pt 2):625-8
Disproportionate HLA matching may contribute to racial disparity in
patient survival following cardiac transplantation.
Park MH, Tolman DE, Kimball PM.
Medical College of Virginia Hospital, Richmond 23298-0005, USA.
The purpose of this study is to investigate the impact of recipient race
as well as HLA matching upon long-term survival following heart transplantation
(HTx). The study also determines whether the degree of HLA matching between
Caucasians and African Americans differs. This study was a retrospective
analysis of 336 males (77% Caucasians and 23% African Americans) transplanted
between 1983 and 1994, all having received cyclosporine-based immunosuppression.
The results showed African Americans were transplanted at a significantly
younger age than Caucasians (39.1 +/- 11.2 vs. 48.2 +/- 10 yr). The composition
of end stage cardiac disease was startlingly different. Caucasians demonstrated
62% CAD, 31% IDCM and 7% other, whereas African Americans exhibited 24%
CAD, 69% IDCM and 7% other. The ten-year survival rate for African American
male recipients was inferior to Caucasian males. Survival at 1, 3, 5,
7 and 9 yr was 83%, 73%, 63%, 51%, 46% for Caucasians and 70%, 58%, 51%,
38% and 32% for African Americans. Furthermore, African Americans received
more poorly matched organs compared to Caucasians. Among Caucasians for
Class I, 46%, 53% and 1% received poor, moderate and well matched hearts,
respectively. In contrast, African American were allocated 65%, 33% and
0% of poor, moderate, or well matched hearts. An analysis of Class II
data revealed the same pattern (63%, 35% 2% of Caucasians and 78%, 18%,
and 4% of African Americans received poor, moderate or well matched hearts).
Survival for Caucasians improved when moderately versus poorly matched
for Class I. Class II matching did not have an effect. African Americans
showed a similar trend, although statistical significance was not reached.
When comparing equivalent degrees of matching, African Americans had inferior
survival rate when poorly matched for Class I relative to Caucasians.
No statistical difference was observed for moderate matched Class I or
for Class II analysis.
PMID: 8996755 [PubMed - indexed for MEDLINE]
