Donor Race Does Not Predict Graft Failure After Liver Transplantation

Background & Aims

Donor race has been proposed to predict graft failure after liver transplantation. We evaluated the extent to which the center where the transplantation surgery was performed and other potential confounding factors might account for the observed association between donor race and graft failure.

Methods

We analyzed data from the Organ Procurement and Transplantation Network (January 2003–December 2005) for adult patients undergoing primary liver transplantation in the United States. We examined the association between graft failure and the donor races of African American (AA), Caucasian, Asian/Pacific Islander (API), or those classified as other.

Results

Of 10,874 livers that were donated for transplantation, 7631 came from Caucasians, 1579 from AAs, 243 from APIs, and 1421 from others. After 36 months of follow-up evaluation, 2687 grafts failed. Without any adjustments, AA donors (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.00–1.24), API donors (HR, 1.41; 95% CI, 1.12–1.77), and other donors (HR, 1.16; 95% CI, 1.04–1.29) were associated with graft failure. After stratification by center and adjustments for age, height, and hepatitis B core antibody status of donors as well as serum creatinine and hepatitis C status of recipients, donor race was no longer statistically significant for AA (HR, 1.06; 95% CI, 0.95–1.20) and API (HR, 1.15; 95% CI, 0.89–1.49) donors. However, livers donated from members of other race still had an increased risk of graft failure (HR, 1.19; 95% CI, 1.05–1.35), although the effect was not uniform across donor–recipient pairs.

Conclusions

Donor race is not a uniform predictor of graft failure and should not be construed as an indicator of donor quality.

Keywords: African American, Donor Factors, Organ Allocation, Donor Risk Index

Abbreviations used in this paper: AA, African American, API, Asian or Pacific Islander, CI, confidence interval, DRI, Donor Risk Index, HR, hazard ratio, LTx, liver transplantation, MELD, Model for End-Stage Liver Disease