03 June 2025 : Original article
Effects of Donor-Recipient Race Matching on Kidney Transplant Survival
Marie Chisholm-Burns
ABDEF 1*, Christina Spivey ABCDEF 1, Richard Formica ADEF 2
DOI: 10.12659/AOT.947720
Ann Transplant 2025; 30:e947720
Table 1 Description of graft and patient survival outcomes of included studies (n=7) [2,5,24–28].
| Study | Database/ transplant center | Study dates | Total study (kidney transplant recipient) population | Recipient characteristics | Donor type | Graft survival or loss outcomes as specified in study | Patient survival or mortality outcomes as specified in study |
|---|---|---|---|---|---|---|---|
| Gaston et al 1992 []5 | University of Alabama at Birmingham | February 1985 to July 1990 | 642 (Group 1 [triple IST, transplanted 1985–1987]: n=276; Group 2 [quadruple IST, transplanted 1987–1990]: n=366) | Male: 402 (Group n=1, 176; Group 2, n=226)Female: 240 (Group 1, n=100; Group 2, n=140)Age: Group 1 mean 39.8 years, SD 0.6; Group 2 mean 40.1 years, SD 0.6Race: White (n=343 [Group 1, n=163; Group 2, n=180]); Black (n=299 [Group 1, n=113; Group 2, n=186) | Deceased | 1-year survival rates in Group 2:Black-Black (n=25) vs White-Black D/R pairing (n=159): NSSurvival from at least 3 months to 36 months post-transplant: Group 1, Black recipients “fared worse” than White recipients, regardless of donor race (p values not provided); Group 2, D/R pairings were NS | Not applicable |
| LeClaire et al 2021 []2 | OPTN/UNOS | 1999–2018 | 265,177 | Gender and age data not providedRace: White (n=134,972); Black (n=69,470) | Deceased, living related, living unrelated | Race-matched vs Mismatched-White: NSRace-matched vs Mismatched-Black: NSRace-matched vs Mismatched-White: NSRace-matched vs Mismatched-Black: decreased survivalRace-matched vs Mismatched-White: increased survivalRace-matched vs Mismatched-Black: decreased survivalRace-matched vs Mismatched-White: NSRace-matched vs Mismatched-Black: decreased survivalRace-matched vs Mismatched-White: NS [HR: 0.958 (95% CI 0.913–1.006), p=.084]Race-matched vs Mismatched-Black: decreased survival [HR: 1.118 (95% CI 1.066–1.172), p<.001] | Race-matched vs Mismatched-White: NSRace-matched vs Mismatched-Black: NSRace-matched vs Mismatched-White: NSRace-matched vs Mismatched-Black: decreased survivalRace-matched vs Mismatched-White: NSRace-matched vs Mismatched-Black: NSRace-matched vs Mismatched-White: NSRace-matched vs Mismatched-Black: NSRace-matched vs Mismatched-White: NS [HR: 1.024 (95% CI 0.973–1.078), p=.368]Race-matched vs Mismatched-Black: NS [HR: 1.056 (95% CI 0.999–1.116), p=.056] |
| Meier-Kriesche et al 2000 []24 | USRDS | October 1, 1988 to June 30, 1997 | 59,509 | Male: 25,675Female: 16,518Age: 18–49 years, n=28,188 (mean 36.3, SD 8.1); 50–64 years, n=11,669 (mean 56.3, SD 4.2); 65 years and older, n=2336 (mean 68.1, SD 2.9)Race/ethnicity: White (n=42,193); Black (n not provided)(Note: gender and age data provided for White recipients only) | Deceased (n=31,213)Living (n=10,980)(Note: data provided for White recipients only) | Black-White D/R pairing vs White-White D/R pairing: increased risk [RR: 1.26, 95% CI 1.12–1.421; p=.0001] | Not applicable |
| Opelz et al 1977 []25 | Over 100 North American transplant centers | January 1970 to December 1975 | 5969 | Gender and age data not providedRace: White (n=5251); Black (n=1134) | Deceased: White, n=3581; Black, n=978Living related:1826 (White, n=1670; Black, n=156) | White-Black D/R pairing: 1-year and 3-year post-transplant, decreased survivalBlack-White D/R pairing: 1-year and 3-year post-transplant, decreased survivalBlack-Black D/R pairing: 1-year and 2-year post-transplant, decreased survival(vs White-White D/R reference group) | Statistical association described as being independent of recipient’s race. Recipients (regardless of race) of White donor organs had significantly better patient survival than recipients (regardless of race) of Black donor organs at 1 year, 2 years, and 3 years post-transplant |
| Perdue & Terasaki 1982 []26 | UCLA International Transplant Registry | 1968–1981 | 14,211 | Gender and age data not providedRace: White (n=11,582); Black (n=2335) | Deceased (n=10,928); Living Related (n=3283) | Black recipients “tend to have lower graft survival rates in all classes of transplants” compared to White recipients, except for grafts from Black donors (no p values reported).“The most highly significant differences in survival … are between” White donor groups. White recipients (White-White D/R pairings) have significantly higher graft survival rates than Black recipients (White-Black D/R pairings) at 3 months, 1 year, and 5 years post-transplant.Black deceased donor kidneys had lower graft survival rates than White deceased donor kidneys in all recipient races (no p values reported) | Patient survival rates (3 months, 1 year, and 5 years post-transplant) “were essentially the same” but rates for the White-Black D/R pairing were “somewhat lower” than rates for White recipients. No p values reported |
| Tiwari et al 1987 []27 | UCLA International Transplant Registry | January 1983 (end date not provided in study) | 5234 (however, 6396 “cases” are reported in of article [3904 CsA group, 2492 no CsA group])Table 1 | Gender and age data not providedRace: White (n=4471); Black (n=821) | Deceased | White-Black vs White-White D/R pairing: decreased survival | Not applicable |
| Vincenti et al 1978 []28 | University of California, San Francisco | January 1970 to March 1977 | 510 | Male=285Female=225Age: mean 34 years, SD 6Race/ethnicity: White (n=386); Black (n=97) | Deceased | White-White vs Mismatched-White D/R pairing: NSBlack-Black vs Mismatched-Black D/R pairing: NS | Not applicable |
| CI – confidence interval; CsA – cyclosporine; D/R – donor-recipient; HR – hazard ratio; IST – immunosuppressant therapy; NS – not significant; OPTN – Organ Procurement and Transplantation Network; RR – risk ratio; SRTR – Scientific Registry of Transplant Recipients; UCLA – University of California, Los Angeles; UNOS – United Network for Organ Sharing; USRDS – United States Renal Data System. a Caveat: Study did not specify if patient population included pediatrics. | |||||||