Previous research has shown that race and economic status negatively impact children’s heart transplant (HT) outcomes. To determine the effect of race on access to left ventricular assist devices (LVAD) and survival outcomes after HT in children, investigators conducted a retrospective analysis of demographic and clinical data, health insurance status, and etiologies of heart failure (HF) in patients who had LVAD as a bridge to HT between 2011 and 2020. They characterized etiologies of HF into two groups, CHD and non-CHD, and race as Black, Other (Hispanic and Asian), and White. Use of LVAD at the time of HT was assessed according to racial group. Among 4,165 patients who had a HT during the study period, 962 had an LVAD. LVAD use was significantly higher in Black patients (27%) compared with Hispanic and Asian (Other) patients (25%) and White patients (20%; P<0.01), and Black patients were more likely older (>10 years), male (59%), and heavier, with higher creatinine and largely public health insurance compared to White and Others (all P values <0.01). For Black patients, the etiology of HF was CHD (18%) compared with no CHD (68%), but was not significantly different than the other two groups. Multivariate regression demonstrated that race and insurance type were not significantly associated with LVAD usage, but age group (OR, 1.6; CI, 1.3-2.1) and non-CHD etiology (OR, 8.7; CI, 7.1-10.6) correlated with greater LVAD use.!/9349/presentation/7945