Solid organ donor–recipient race‐matching: analysis of the United Network for Organ Sharing database

Abstract

Summary Donor ethnicity is a prognosticator in organ transplant. However, the impact of donor/recipient race‐matching is unclear. We hypothesized that there would be increased survival in donor–recipient race‐matched organ recipients because of genetic and physiologic similarities. The UNOS database from 1999 to 2018 was queried for all solid organ transplantations including heart, lung, liver, kidney, and pancreas transplants. Data were sorted by donor and recipient race into matched and unmatched categories for Caucasian, African American, and Hispanic transplant recipients. After controlling for potential confounders via inverse propensity of treatment weighting, post‐transplant patient and graft survival were compared between race‐matched and ‐unmatched donor groups for each organ. Race‐matched Caucasian recipients experienced 1–3% improvement in mortality across most time points in lung, liver, and pancreas transplants, while Hispanics did not benefit. Matched African American recipients experienced 4–6% improvement in patient and graft survival in liver transplant but had 7–9% worse survival rates at 5 years in lung and pancreas transplants. Race‐matching does not influence patient outcomes enough to factor into organ transplant offers. African American liver transplant recipients benefited the most. Matching was detrimental to African American lung and pancreas transplant recipients indicating there may be other factors influencing the outcomes of these transplants.

Simpson's paradox and the impact of donor-recipient race-matching on outcomes post living or deceased donor kidney transplantation in the United States

“…LeClaire et al (11) conducted an analysis of solid organ (including heart, lung, liver, kidney, and pancreas) transplantations from the UNOS database and reported that patient survival in KT was not influenced by race-matching, but race-unmatched African Americans experienced shorter graft survival at all time points after controlling for potential confounders, which was inconsistent with our results. In our results, the crude patient and graft survival rates in racematching were significantly higher than those in raceunmatching.…”

“…Donor-recipient race-matching is considered a potential prognostic factor for organ transplant outcomes, since receiving organs from the same race increases the possibility of genetic and physiological similarities between donors and recipients and thereby reduces the possibility of rejection events (7). However, few studies (8)(9)(10)(11)(12) have investigated the impact of donor-recipient race-matching on post-transplant survival, especially in KT. Although some studies have noted reduced survival of patients or grafts in race-unmatched organ transplantation, conflicting results have been reported in several studies.…”

Influence of Donor Race and Donor-recipient Race-matching on Pediatric Kidney Transplant Outcomes

“…Our results indicated that race-matched status was not significant to DGF, graft failure, acute rejection, or mortality. LeClaire et al 18 conducted a study that also explored the effects of race-matching using the OPTN database, and their study included adults who underwent heart, lung, liver, kidney, and pancreas transplants. 18 There were slight variations in some organ transplant outcomes due to race-matching, but the results were not strong enough to suggest race-matching should be considered when matching donors and recipients.…”

“…LeClaire et al 18 conducted a study that also explored the effects of race-matching using the OPTN database, and their study included adults who underwent heart, lung, liver, kidney, and pancreas transplants. 18 There were slight variations in some organ transplant outcomes due to race-matching, but the results were not strong enough to suggest race-matching should be considered when matching donors and recipients. Contrary findings resulted from Allen et al’s study, 26 which also used the OPTN database and found that race-matching of adult liver transplant pairs resulted in improved long-term survival but did not confer any advantages for decreased rejection after 1 y.…”

“…Studies have begun to explore race-matching of donors and recipients in organ transplants, and findings thus far are mixed but encouraging. Data from LeClaire et al 18 suggest that race-matching of organ transplant donors and recipients does not confer significant improvement in transplant outcomes for any race, whereas Silva et al 19 found that donor-recipient race-matching of patients undergoing liver transplants resulted in significantly improved outcomes for those with hepatocellular carcinoma. Studies are beginning to examine race-matching in pediatric transplant patients, and data have shown that race-matching predicts increased graft survival in pediatric heart transplant patients.…”