# Donor–Recipient Race Mismatch Is Associated with Lower Survival After Liver Transplantation for Primary Sclerosing Cholangitis

## TL;DR

Black patients who receive livers from White donors have lower 5-year survival after liver transplants for primary sclerosing cholangitis compared to White donor-recipient matches.

## Contribution

This study identifies a survival disparity in liver transplant recipients based on donor-recipient race mismatch for primary sclerosing cholangitis.

## Key findings

- Five-year patient survival was 86.0% for White–Black donor-recipient pairs, significantly lower than White–White pairs (90.8%).
- Black recipients of White donor livers had a 69% higher 5-year mortality risk compared to White recipients of White donor livers.
- Race mismatch between donor and recipient was associated with lower survival in Black patients with primary sclerosing cholangitis.

## Abstract

Background: Patient survival after liver transplantation is lower in donor–recipient race mismatched patients for indications other than primary sclerosing cholangitis. Objectives: To determine if survival is lower after liver transplantation in donor–recipient race mismatched recipients with primary sclerosing cholangitis. Methods: The Organ Procurement and Transplantation Network database was analyzed for deceased donor adult liver transplant recipients with primary sclerosing cholangitis. Graft and patient survival by donor–recipient race were estimated using Kaplan–Meier survival method and compared using the log-rank test. Multivariable analysis was performed using Cox regression. Results: From 2002 to 2018, 5-year patient survival in White (n = 2223) and Black recipients (n = 491), was 89.8% and 87.1%, respectively. Five-year patient survival for the donor–recipient pairs, White–White (n = 1622), Black–Black (n = 110), Black–White (n = 335), and White–Black (n = 314) was 90.8%, 91.1%, 87.1%, and 86.0%, respectively, p = 0.026. In multivariable analysis, 5-year patient mortality was higher in Black recipients of White donors [HR 1.69, 95% CI 1.16, 2.45], compared to White recipients of White donors. Conclusions: Five-year patient mortality after deceased donor liver transplantation for primary sclerosing cholangitis is higher in Black recipients who received livers from White donors compared to matched White donors and recipients.