Disparities while listing for orthotopic heart transplantation: A systematic review and meta-analysis

Abstract

Background: Disparities in orthotopic heart transplant (OHT) listing exist due to race, gender, insurance access, socioeconomic status (SES) and access to healthcare. This study aims to investigate the impact of these factors on the inequities encountered within the pre-transplantation process. Methods: Literature search was conducted up to July 2024, focusing on disparities in organ transplant outcomes. The primary endpoint was the recipient acceptance rate. Secondary endpoints were donor acceptance, waitlist urgency (status 1, 1A, or 1A exception), waitlist mortality (death while on the list), and waitlist duration (time from listing to transplantation). Results: A total of 40 studies involving 506,459 patients at listing for OHT were included. Disparities in education level, gender, and insurance were not associated with recipient acceptance rate. However, black patients have a significantly lower recipient acceptance rate compared to the white patients (HR 0.86, 95 % CI: 0.84–0.89, I² = 15.8 %). For waitlist urgency, black patients were more likely to be listed for status 1 (OR 1.24, 95 % CI: 1.11–1.39, I² = 85.2 %). For waitlist mortality, there was no significant association with race, gender, insurance, income and education level, but the introduction of the 2018 policy led to a significantly lower waitlist mortality (HR 0.61, 95 % CI: 0.52–0.72, I² = 0.0 %). Conclusion: Race remains a primary determinant of inequity in transplant access. Addressing racial disparity is crucial for achieving equitable access to care for all patients with end-stage heart disease.