Donor-recipient race-ethnicity concordance and patient survival after liver transplantation

We assessed the association between patient survival after liver transplantation (LT) and donor-recipient race-ethnicity (R/E) concordance.

The Scientific Registry of Transplant Recipients (SRTR) was retrospectively analyzed using data collected between 2002 and 2019. Only adults without history of prior organ transplant and recipients of LT alone were included. The primary outcome was patient survival. Donors and recipients were categorized into five R/E groups: White/Caucasian, African American/Black, Hispanic/Latino, Asian, and Others. Statistical analyses were performed using Kaplan-Meier survival curves and Cox Proportional Hazards models, adjusting for donor and recipient covariates.

85,427 patients were included. Among all the R/E groups, Asian patients had the highest 5-year survival (81.3%; 95% CI = 79.9-82.7), while African American/Black patients had the lowest (71.4%; 95% CI = 70.3-72.6) (P < 0.001). Lower survival rates were observed in recipients who received discordant R/E grafts irrespective of their R/E group. The fully adjusted hazard ratio for death was statistically significant in African American/Black (aHR _1.07-1.18_-1.31; P < 0.01) and in White∕Caucasian patients (aHR _1.00-1.04_-1.07; P = 0.03) in the presence of donor-recipient R/E discordance.

Disparities in post-LT outcomes might be influenced by biological factors in addition to well-known social determinants of health.