Heart transplantation is supposed to offer a new lease on life after end-stage heart failure, but new data show that Black recipients are not sharing equally in those long-term gains. Drawing on the national Scientific Registry of Transplant Recipients, researchers analyzed 15,873 adults who received a new heart between 2017 and 2022, comparing outcomes for Black, non-Hispanic White, and other racial groups.
Black patients made up nearly a quarter of transplant recipients and were more likely to be women, publicly insured, and less likely to have a college education than non-Black peers. They also arrived at transplant sicker, with higher use of durable ventricular assist devices and intra-aortic balloon pumps, reflecting greater acuity at the time of surgery.
On paper, early results look similar: one-year graft survival hovered around 92 percent for both Black and non-Black recipients. But by three years, survival diverged. Black patients had significantly lower graft survival and a higher adjusted risk of graft failure that persisted even after accounting for socioeconomic and clinical differences.
Complications that erode quality and length of life also fell more heavily on Black recipients. They experienced higher rates of acute rejection during the initial hospitalization and in the first three years, more new-onset diabetes after transplant, and greater progression of kidney dysfunction than non-Black patients, even though they started with better baseline kidney function.
The authors note that policies have targeted structural and systemic barriers, yet “racial disparities in outcomes after heart transplant persist in the contemporary era” and likely reflect a mix of social and biological factors. They argue that only by understanding these mechanisms can clinicians and policymakers design interventions that ensure Black patients fully benefit from one of medicine’s most life-extending therapies.
See: “Racial Disparities in Heart Transplantation Long-Term Graft Survival and Nonmortality Outcomes” (September 25, 2025)
