Background

Gender and racial disparities exist after left ventricular assist device (LVAD) implantation. Compared with older devices, the HeartMate 3 (HM3) (Abbott Cardiovascular) has demonstrated improved survival. Whether HM3 differentially improves outcomes by gender or race and ethnic groups is unknown.

Objectives

The purpose of this study is to examine differences by gender and race in the use of HM3 among patients listed for heart transplantation (HT) and associated waitlist and post-transplant outcomes.

Methods

The authors examined all patients (20% women, 33% Black) who received LVADs as bridge to transplantation (BTT) between January 2018 and June 2020, in the OPTN (Organ Procurement and Transplantation Network) database. Trends in use of HM3 were evaluated by gender and race. Competing events of death/delisting and transplantation were evaluated using subdistribution hazard models. Post-transplant outcomes were evaluated using multivariate logistic regression adjusted for demographic, clinical, and donor characteristics.

Results

Of 11,524 patients listed for HT during the study period, 955 (8.3%) had HM3 implanted as BTT. Use of HM3 increased for all patients, with no difference in use by gender (P = 0.4) or by race (P = 0.2). Competing risk analysis did not demonstrate differences in transplantation or death/delisting in men compared with women (HT: adjusted HR [aHR]: 0.92 [95% CI: 0.70-1.21]; death/delisting: aHR: 0.91 [95% CI: 0.59-1.42]), although Black patients were transplanted fewer times than White patients (HT: aHR: 0.72 [95% CI: 0.57-0.91], death/delisting: aHR: 1.36 [95% CI: 0.98-1.89]). One-year post-transplant survival was comparable by gender (aHR: 0.52 [95% CI: 0.21-1.70]) and race (aHR: 0.76 [95% CI: 0.34-1.70]), with no differences in rates of stroke, acute rejection, or graft failure.

Conclusions

Use of HM3 among patients listed for HT has increased over time and by gender and race. Black patients with HM3 were less likely to be transplanted compared with White patients, but there were no differences in post-transplant outcomes between these groups or between men and women.

中文翻译：

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HeartMate3 左心室辅助装置作为移植桥梁的性别和种族差异

背景

左心室辅助装置（LVAD）植入后存在性别和种族差异。与旧设备相比，HeartMate 3 (HM3)（雅培心血管）已证明生存率有所提高。HM3 是否因性别或种族和族裔群体而有差异地改善结果尚不清楚。

目标

本研究的目的是检查列入心脏移植 (HT) 的患者中使用 HM3 的性别和种族差异以及相关的候补名单和移植后结果。

方法

作者在 OPTN（器官获取和移植网络）数据库中检查了 2018 年 1 月至 2020 年 6 月期间接受 LVAD 作为移植桥梁 (BTT) 的所有患者（20% 女性，33% 黑人）。按性别和种族评估 HM3 的使用趋势。使用次分布风险模型评估死亡/除名和移植的竞争事件。使用针对人口、临床和供体特征进行调整的多变量逻辑回归来评估移植后结果。

结果

在研究期间列入 HT 的 11,524 名患者中，955 名 (8.3%) 植入了 HM3 作为 BTT。所有患者的 HM3 使用量均有所增加，但性别 ( P = 0.4) 或种族 ( P = 0.2) 的使用情况没有差异。竞争风险分析并未显示男性与女性相比在移植或死亡/除名方面存在差异（HT：调整后 HR [aHR]：0.92 [95% CI：0.70-1.21]；死亡/除名：aHR：0.91 [95% CI： 0.59-1.42]），尽管黑人患者的移植次数少于白人患者（HT：aHR：0.72 [95% CI：0.57-0.91]，死亡/除名：aHR：1.36 [95% CI：0.98-1.89]）。移植后一年的生存率在性别（aHR：0.52 [95% CI：0.21-1.70]）和种族（aHR：0.76 [95% CI：0.34-1.70]）方面具有可比性，中风发生率没有差异，急性排斥反应或移植失败。

结论

随着时间的推移、性别和种族的不同，HM3 在 HT 患者中的使用有所增加。与白人患者相比，携带 HM3 的黑人患者接受移植的可能性较小，但这些群体之间或男性和女性之间的移植后结果没有差异。