Purpose The purpose of this study is to look at impact of race on thoracic organ recipient (TOR) survival with respect to the donor, recipient, and donor/ recipient matching. Methods The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from 1/2000-3/2018 for donor hearts or lungs. After exclusions for multiorgan transplant and age (donor < 15 years(y), recipient < 18y), 63824 patients went on to transplant. The donor races were divided into African-American (AA), Hispanic (H), and white (W). Donors outside these categories were excluded due to small sample size. The primary outcomes were 30 day, 1 year, and long-term survival with regards to the race of the donor and the recipient independently as well as matched and unmatched donor/ recipient pairs. Modeling was done via logistic and Cox models. Results Donor age ranged from 15-77 y (mean 33.2y, median 31y). 66% were male, and 4% were diabetic. The mean donor ejection fraction (EF) was 60% (median 60%) and ischemic time ranged from 0.04-15 hours (h) for both heart and lungs (mean 4.00h, median 3.72h). There were 9914 (17%) AA, 9081 (15%) H, and 40003 (68%) W thoracic organ donors. Adjusted 30-day and 1 year survival of TORs was 96.2% and 87.7% from AA donors, 96.2% and 87.6% from H donors, and 96.5% and 89% from W donors. This equates to a 13% reduction in 1-year survival among AA and H donors when compared to W donors (both OR=0.87; p<0.001). H and AA TORs showed no differences in 30 day or 1 year survival compared to their W counterparts (all p>0.068). AA exhibited lower long-term survival when compared to W (HR=1.12; p<0.001), but H exhibited longer survival compared to W (HR=0.94; p=0.047). Racially matched donor-recipient pairs showed higher rates of survival at 30 days (OR=1.17; p=0.002), 1 year (OR=1.16; p<0.001), and overall survival (HR=0.90; p<0.001). Conclusion While there is evidence of racial disparity in survival outcomes after thoracic organ transplant matched race donor/ recipient may improve thoracic transplant survival. The purpose of this study is to look at impact of race on thoracic organ recipient (TOR) survival with respect to the donor, recipient, and donor/ recipient matching. The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from 1/2000-3/2018 for donor hearts or lungs. After exclusions for multiorgan transplant and age (donor < 15 years(y), recipient < 18y), 63824 patients went on to transplant. The donor races were divided into African-American (AA), Hispanic (H), and white (W). Donors outside these categories were excluded due to small sample size. The primary outcomes were 30 day, 1 year, and long-term survival with regards to the race of the donor and the recipient independently as well as matched and unmatched donor/ recipient pairs. Modeling was done via logistic and Cox models. Donor age ranged from 15-77 y (mean 33.2y, median 31y). 66% were male, and 4% were diabetic. The mean donor ejection fraction (EF) was 60% (median 60%) and ischemic time ranged from 0.04-15 hours (h) for both heart and lungs (mean 4.00h, median 3.72h). There were 9914 (17%) AA, 9081 (15%) H, and 40003 (68%) W thoracic organ donors. Adjusted 30-day and 1 year survival of TORs was 96.2% and 87.7% from AA donors, 96.2% and 87.6% from H donors, and 96.5% and 89% from W donors. This equates to a 13% reduction in 1-year survival among AA and H donors when compared to W donors (both OR=0.87; p<0.001). H and AA TORs showed no differences in 30 day or 1 year survival compared to their W counterparts (all p>0.068). AA exhibited lower long-term survival when compared to W (HR=1.12; p<0.001), but H exhibited longer survival compared to W (HR=0.94; p=0.047). Racially matched donor-recipient pairs showed higher rates of survival at 30 days (OR=1.17; p=0.002), 1 year (OR=1.16; p<0.001), and overall survival (HR=0.90; p<0.001). While there is evidence of racial disparity in survival outcomes after thoracic organ transplant matched race donor/ recipient may improve thoracic transplant survival.

Donor and Recipient Racial Mismatch Impacts Thoracic Organ Transplant Survival