Trends in survival after heart transplantation based on Social Vulnerability Index in the United States.

Background: The association of social vulnerability (SV) and cardiac transplant survival remains poorly defined, particularly related to long-term outcomes. The purpose of this study was to define the impact of SV on survival among heart transplant recipients with at least 1 year of survival post-transplant.

Methods: Heart transplant recipients were identified using the United Network for Organ Sharing database between June 1, 2006, and December 31, 2020. The Center for Disease Control's Social Vulnerability Index (SVI) database was used to stratify patients based on SVI into 3 groups: low: <25; average: 26 to 74; high: 75+. The groups were analyzed with comparative statistics, and unadjusted survival was assessed using Kaplan-Meier methods. To determine the independent association between SVI and survival, a multivariable Cox proportional hazard model was created.

Results: There were 27,740 recipients identified. High SVI patients more commonly identified as Black individuals and had a higher incidence of diabetes, pretransplant intensive care unit admission, and need for concomitant kidney transplant ( < 0.05 for all). Additionally, high SVI patients had the longest length of stay post-transplant (21.4 days) ( < 0.05). High and average SVI patients had inferior 3-year, 5-year, and 10-year survival vs low SVI patients ( < 0.05). After adjustment, average (hazard ratio [HR]: 1.12) and high (HR: 1.16) SVI were independently associated with an increased risk of mortality on multivariable analysis (both  < 0.001).

Conclusion: High or average SVI is independently associated with increased mortality following heart transplantation in patients with 1-year conditional survival. These findings demonstrate that disparities persist among heart transplant recipients during long-term follow-up.