Racial Disparities in Heart Transplantation: Long‐Term Graft Survival and Nonmortality Outcomes

Background Prior studies have reported conflicting evidence on racial disparities in heart transplant outcomes, often focusing only on short‐term mortality rates. We assessed longer‐term survival and a broader range of post–heart transplant outcomes by race. Methods We analyzed adult heart transplant recipients from 2017 to 2022 in the SRTR (Scientific Registry for Transplant Recipients), categorizing race as Black, non‐Hispanic White, or Other. The primary outcome was graft failure at 1 and 3 years. Secondary outcomes included acute rejection, renal dysfunction, and posttransplant diabetes. χ 2 tests and Kaplan–Meier/logistic regression analyses were used. Results Among 15 873 recipients (63% White, 23% Black, 14% Other), Black recipients were more likely female, publicly insured, and less likely to be college educated. They also had higher use of durable ventricular assist devices and intra‐aortic balloon pump at transplant. One‐year graft survival was similar across groups (91.8% Black versus 91.1% non‐Black), but 3‐year survival was lower among Black individuals (83.4% versus 85.7%, P =0.006). After adjusting for socioeconomic and clinical factors, Black recipients had a higher risk of graft failure at 3 years (odds ratio, 1.22 [95% CI, 1.07–1.39]). Black patients also experienced higher rates of acute rejection (12.4% versus 10.2%), diabetes (10.8% versus 7.1%), and renal dysfunction progression (40.9% versus 37.1%) at 3 years ( P <0.05 for all). Conclusions Racial disparities in heart transplant outcomes persist, particularly in longer‐term survival. These disparities may be partially mediated by differences in posttransplant complications such as rejection, renal dysfunction, and diabetes.