Ethnic Disparity in Israel Impacts Long-Term Results After Heart Transplantation

Background:

It has been previously shown that ethnicity is a predictor of graft longevity and recipient mortality in heart transplantation (HTx). We hypothesized that ethnic differences between Arabs and Jews undergoing HTx may contribute to differences in long-term outcomes.

Methods:

All 254 patients who underwent HTx between 1991 and 2017, were ethnically categorized to Jews (226 patients, 89%) vs. Arabs (28 patients, 11%). The primary outcomes included allograft vasculopathy (CAV), cardiovascular (CVS) mortality and combined end point of CAV/CVS mortality.

Results:

Preoperatively both groups were clinically similar, except for younger age and shorter in-hospital stay in the Arabs patients. Kaplan-Meier survival analysis showed a higher 10-years CAV rate among the Arab recipients ( 58.2% vs. 23.5%, log-rank p =.011). Similarly, CVS death rate and the combined end point of CAV/CVS mortality were significantly higher in the Arab recipients (Figure). Consistently multivariate analysis showed Arab recipient origin to be associated with a significant >2-fold increase in the risk for CAV (HR=2.69, 95% CI [1.24, 5.77], p= .010); >4-fold increase in the risk for CVS death (HR=4.78, 95% CI [1.34, 42.93], p= .001) and >6-fold increase in the risk for the combined end-point (HR=6.99, 95% CI [2.55, 18.36], p= .001). These findings were validated by propensity score analysis.

Conclusions: Arab origin is associated with a significant increased risk for CAV and mortality after HTx compared to patients of Jewish origin. Ethnic differences should be considered in the risk assessment and long-term management in this population.