Cardiology Medical News about pediatric heart transplant recipients;graft failure;socioeconomic position

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Socioeconomic position and graft failure in pediatric heart transplant recipients
Circulation: Heart Failure, 04/10/09

Singh TP et al. - In a trial to assess whether pt socioeconomic (SE) position, determined for the block group of pt residence (average population 1000, smallest census unit with SE data), is associated with graft failure in pediatric heart transplant recipients, it was concluded that low SE position may be an independent risk factor for graft failure in pediatric heart transplant recipients.

Methods

US Census 2000 database was used to derive a composite SE score for the block group of residence for all pts who underwent their first heart transplant at Children's Hospital Boston between 1991 and 2005 (n=135).
Cox proportional hazards models were used to determine the risk of graft failure (death or re-transplant) in the lowest tertile SE group (low SE group) vs the remaining 2/3 pts (controls).

Results

The 2 groups were similar with respect to age, gender, diagnosis and year of transplant.
White race was less frequent in low SE group (64% vs 90%).
Graft failure occurred in 46 transplant recipients (40 deaths, 6 re-transplant).
Low SE group (hazard ratio (HR) 2.4) and nonwhite race (HR 2.7) were both associated with higher risk of graft failure.
In a multivariable model controlling for diagnosis and pre-transplant support, race and low SE position (HR 2.0) remained associated with graft failure.
Low SE position group had a higher incidence rate of graft rejection and was at a higher risk of late rejection.

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