Effects of Donor-Recipient Race Matching on Kidney Transplant Survival

BACKGROUND Given the scarcity of donor organs in the United States, the ability to prolong kidney transplant graft survival is a significant public health concern. Although it has been suggested that donor-recipient race-matching could improve kidney transplant outcomes, findings of previous studies are inconsistent. Therefore, the objective of this study was to conduct a systematic review examining the relationship between Black and White donor-recipient race-matching and graft and patient survival in adult primary kidney transplant recipients. MATERIAL AND METHODS Ovid Medline and Embase literature searches were conducted from earliest index date through October 2024. The following data were extracted and summarized: study characteristics, patient population characteristics, and findings associated with graft and patient survival. Quality assessment and magnitude of effects were evaluated, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to determine evidence certainty. RESULTS Of 4676 citations, 7 studies met inclusion criteria. Two studies reported Black-Black donor-recipient pairings, 2 studies reported Black-White donor-recipient pairings, and 3 studies reported White-Black donor-recipient pairings were at significantly higher risk for graft failure than the reference group; however, effect magnitude was small. Studies found the relationship between race-matching and patient survival was not statistically significant. Per GRADE, evidence concerning graft and patient survival is of low certainty or quality. CONCLUSIONS Studies generally found no differences in patient survival, and although Black-Black, Black-White, and White-Black donor-recipient pairings were associated with decreased graft survival in some studies, effects were small and likely clinically irrelevant. Further investigation of modifiable factors influencing graft survival is needed.