Minority children and those in poorer neighborhoods are more likely to die or need a second heart transplant than white children or those in better-off neighborhoods, according to the results of a U.S. study.
The study included 135 children, median age 8.4 years, who received their first heart transplant at Children's Hospital Boston between 1991 and 2005. There were 110 white children, 10 black children, eight Hispanic children and seven children from other racial groups.
Overall, 40 children died and six underwent a re-transplant during the study period. Nine of the deaths occurred during the initial hospitalization after the first transplant. Among the children who survived the initial post-transplant hospitalization, there were 31 deaths and six re-transplants over a median of six years.
The study found that:
- Children from low socioeconomic neighborhoods were 2.4 times more likely to require another heart transplant than those from higher socioeconomic neighborhoods.
- Minority children were 2.7 times more likely to need a second transplant than white children.
- Among the nine deaths during initial post-transplant hospitalization, six deaths (13.3 percent) involved children in the lower socioeconomic group and three (3.3 percent) involved children in the higher socioeconomic group.
- Children in the lower socioeconomic group had much lower rates of transplanted heart survival at 12 months, three years and five years after the transplant.
- Time to death or re-transplantation was significantly shorter for children in the lower socioeconomic group. They also had a higher risk of rejection of their transplanted heart.
"Low socioeconomic status and non-white race appear to be independent risk factors for worse outcomes," lead author Dr. Tajinder P. Singh, a transplant cardiologist at Children's Hospital Boston and Harvard Medical School, said in a news release.
These children may be sicker when they arrive at the transplant center or they "may have difficulty using available resources from the medical community, which may reflect the lack of resources available to them at a personal and family level," Singh said.
The findings, published in the journal Circulation: Heart Failure, should be considered preliminary and need to be confirmed in larger population groups, the researchers noted.
"Improving the outcomes of heart transplantation in the lower socioeconomic status children requires new strategies and interventions for patients, families and the medical system," Singh said.
More information
The American Heart Association has more about children and heart transplants.
SOURCE: American Heart Association, news release, April 7, 2009
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