Combined Heart-Lung Transplantation Outcomes in Asian Populations: National Database Analysis

Yasuhiro Shudo; Matthew Leipzig; Hao He; Shreya Mukund Ingle; Rishab Harish Bhatt; Hye-Sook Shin; Y Joseph Woo

doi:10.1016/j.jacasi.2022.03.012

Combined Heart-Lung Transplantation Outcomes in Asian Populations: National Database Analysis

JACC Asia. 2022 Jul 5;2(4):504-512. doi: 10.1016/j.jacasi.2022.03.012. eCollection 2022 Aug.

Authors

Yasuhiro Shudo¹, Matthew Leipzig¹, Hao He¹, Shreya Mukund Ingle^{1

2

3}, Rishab Harish Bhatt^{1

3

4}, Hye-Sook Shin¹, Y Joseph Woo¹

Affiliations

¹ Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA.
² Department of Natural Sciences, Rice University, Houston, Texas, USA.
³ Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California, USA.
⁴ Departments of Neuroscience and Behavioral Biology and Computer Science, Emory University, Atlanta, Georgia, USA.

Abstract

Background: Heart-lung transplantation (HLTx) is a definitive surgical procedure for end-stage cardiopulmonary failure. Studies to understand the relationship between ethnicity and race and outcomes after HLTx are needed to uphold equitable HLTx access to the increasingly diverse U.S. population facing advanced cardiopulmonary failure.

Objectives: This study sought to examine the outcomes of HLTx recipients of Asian origin, with emphasis on the ethnic and racial disparities in the outcomes.

Methods: We analyzed data from the United Network for Organ Sharing (UNOS) for patients of ≥18 years of age who underwent HLTx between 1987 and 2021. Propensity-score matching was performed between Asian and non-Hispanic Whites (NHWs), with a 1:3 matching ratio based on the propensity score of each patient estimated by multivariable logistic regression.

Results: We identified 42 Asian and Asian American heart-lung transplant recipients and 834 NHW recipients. In the pre-matched cohort, the median survival was 1,459 days (IQR: 1,080-2,692 days) in Asian recipients after transplantation, whereas it was 1,521 days (IQR: 1,262-1,841 days) in White recipients. Of the 876 recipients, 156 transplants were successfully matched (Asian, n = 36; NHW, n = 108). Among the post-transplantation outcomes, there were no significant differences in morbidity and mortality between Asian and NHW cohorts.

Conclusions: This large-scale analysis in Asian patients will have important implications in Asian countries that have relatively fewer HLTx surgeries. An outcome equivalent to NHW in Asian patients, as demonstrated in our study, could be the driving force for further expansion of HLTx surgeries in Asian countries.

Keywords: Asian Americans; BMI, body mass index; ECMO, extracorporeal membrane oxygenation; HLTx, heart-lung transplantation; NHW, non-Hispanic White; UNOS, United Network for Organ Sharing; heart-lung transplantation; morbidity; propensity score.