Regional disparities in heart transplant mortality in the United States

Background Mortality after heart transplantation can be influenced by multiple factors. This study analysed its variation across four regions of the USA. Objective Analyse the differences in mortality among patients receiving a heart transplant across four regions of the USA. Methods and results Organ Procurement and Transplantation Network/United Network for Organ Sharing registry was analysed for adult heart transplant recipients from 1987 to 2023. They were divided into four regions according to heart transplant recipients’ residence: the Northeast, Midwest, South, and West. The endpoint was all-cause mortality. A total of 33 482 heart transplant recipients were included in the analysis. Baseline characteristics differed by region. The median survival (years) was lower in the South [Northeast 12.9 (6.1–17.9), Midwest 13.1 (6.5–18.1), South 11.6 (5.3–16.8), and West 13.6 (7.0–18.6); P < 0.0001]. Mortality incidence rate was greater in the South. When compared to the Northeast, in the unadjusted analysis, mortality was higher in the South {hazard ratio (HR) 1.13 [95% confidence interval (CI) 1.07–1.19], P < 0.001} and lower in the West [HR 0.89 (95% CI 0.83–0.94), P < 0.001]. After adjusting for demographic and clinical variables, only the South retained significant differences [HR 1.17 (95% CI 1.10–1.24), P < 0.001]. Mortality significantly increased in all regions after 2018. Conclusion Mortality of heart transplant recipients varies across region of residence in the USA. A significant increase in adjusted mortality was observed in the South. These findings suggest that there are regional disparities in the mortality rates of heart transplant recipients.