The Effect of Donor-Recipient Race and Ethnicity Match on Liver Transplantation Outcome in the United States

Introduction: Recipient race/ethnicity (R/E) affect liver transplantation (LT) outcomes. However, the effect of donor R/E or donor-recipient R/E match is not well studied. We aimed to describe the impact of different donor and recipient R/E match on post-LT survival in the United States. Methods: We performed a retrospective study using the Scientific Registry of Transplant Recipient (SRTR) database. Donors and recipients are categorized into five R/E groups: Asian, Black, Latino, non-Latino White, and Others. We used Kaplan-Meier and Cox Proportional Hazards models for statistical analyses, adjusted for donor and recipient covariates. Results: 85,427 LT recipients between 2002 and 2019 were included in this study. Compared to non-Latino white donors or recipients, Asian and Black recipients had the lowest and highest risk of post LT mortality, respectively. Additionally, multivariate-adjusted models demonstrated that receiving Asian donor liver is associated with worse survival in all recipients besides Asians. Furthermore, the mortality risk for Black recipients normalized only when receiving livers from Black donors. However, this advantage of exact R/E matching is not distinctly evident in other R/E groups. Lastly, the effect size of donor and recipient R/E on post-LT survival is comparable to, if not higher than, many other known risk factors such as BMI, receiving cardiac death donor grafts, etc., suggesting unknown sources of variance. Conclusion: Donor and recipient R/E has significant associations with post-LT overall survival. Further studies must identify the uncharacterized social determinants of health and biologic factors with particular attention to addressing systemic racism within practice of LT.