Black pediatric cardiac transplant recipients experience perioperative stroke less frequently than White pediatric cardiac transplant recipients. Mortality among the survivors of perioperative stroke is initially similar, but after 6 months these Black children experience more than 3 times the mortality rate of the White children. These are among the study findings published in the Journal of the American Heart Association.
Researchers sought to evaluate racial and ethnic differences in occurrence of stroke following cardiac transplant and all-cause mortality after perioperative stroke in pediatric cardiac transplant recipients. The investigators conducted a national prospective cohort study of children in the US who experienced their first heart transplant. They used data from the Scientific Registry of Transplant Recipients database collected between January 1994 and September 2019.
Among the 8224 children included in the study, 3% experienced perioperative stroke (Black n=43, median age at transplant was 6.67 [IQR, 1.29-11.38] years, 83.7% received Medicaid, 14.0% had private insurance, and 53.5% were girls; White n=143, median age at transplant was 3.83 [IQR, 0.58-10.29] years, 42.0% received Medicaid, 51.0% had private insurance, and 44.8% were girls; Hispanic n=69, median age at transplant was 5.42 [IQR, 1.29-11.17] years, 72.3% received Medicaid, 21.3% had private insurance, and 38.3% were girls; Other n=22, median age at transplant was 4.75 [IQR, 1.46-7.54] years, 27.3% received Medicaid, 36.4% had private insurance, and 50.0% were girls).
Compared with White children, the researchers found that Black children had 32% decreased odds of perioperative stroke (adjusted odds ratio, 0.68; 95% CI, 0.470–0.996). For the 6 months following perioperative stroke, Black children and White children saw similar rates for mortality (adjusted hazard ratio [aHR], 0.99; 95% CI, 0.44–2.26).
The researchers said that past 6 months following perioperative stroke, Black children experienced a greater mortality rate than White children (aHR, 3.36; 95% CI, 1.22–9.22). They noted that there was no statistically significant difference between Hispanic children and White children in mortality rate (aHR, 1.71; 95% CI, 0.53–5.55) or between children of other races and White children (aHR, 2.38; 95% CI, 0.26–22.00).
Study limitations include lack of data availability for social determinants of health, and whether or not strokes are ischemic or hemorrhagic. Additional limitations include the misclassification of some covariates and outcomes, and the small sample size.
Considering all pediatric cardiac transplant recipients, a lower occurrence of perioperative stroke was seen in Black children compared with White children. “Among survivors of perioperative stroke, mortality is initially similar by race and ethnicity, but beyond 6 months, Black children have over a 3-fold higher mortality rate than White children,” the researchers noted. “Identifying and intervening on potential differences in care is essential to addressing these disparities.”
Lehman LL, Mostofsky E, Salia S, et al. Racial and ethnic disparities in incidence and prognosis of perioperative stroke among pediatric cardiac transplant recipients. J Am Heart Assoc. Published online July 13, 2022. doi:10.1161/JAHA.121.025149