The Association between Donor-Recipient Race Matching and Survival Following Lung Transplantation Differs Based on Recipient Race

Abstract

included. Missing data were addressed using multiple imputation. The exposure was donor to recipient race match. The outcome was time to death following transplantation. Patients were censored at the last date they were known to be alive. The propensity to receive a race-matched organ, based on available covariates, was calculated using logistic regression. A Cox regression model was used to compare the hazard of death for patients who did and did not receive a racematched organ, adjusted for their propensity to receive a race-matched organ. Results: There were 13464 lung transplants for which the donor and recipient races were known that occurred between May 4, 2005 and May 3, 2014. 59% (8005) were men and the median age was 58 years. The indication for transplant was obstructive disease in 30% (4088), pulmonary vascular disease in 4% (485), cystic fibrosis or immunodeficiency in 13% (1786), and restrictive disease in 53% (7101). 57% (7642) received lungs from race-matched donors and 43% (5822) received lungs from race-mismatched donors. The median survival time was 5.7 years. Recipient race was identified as an effect measure modifier. The propensity-adjusted hazard of death for Caucasian patients who received race-matched lungs compared to those who did not was 0.88 (95% CL 0.82, 0.95; p= 0.0003). There was no difference in the propensity-adjusted hazard of death for African American or non-Caucasian, non-African American recipients who received race-matched lungs compared to those who did not. Conclusion: Race mismatch between donor and recipient is common in lung transplantation. In Caucasian patients, use of a race-matched lung was associated with a reduced hazard of death. African American and non-Caucasian, non-African American patients who received a race-matched lung did not have the same reduction in the hazard of death.