Impact of Donor-Recipient Race Matching on Survival After Lung Transplantation: Analysis of Over 11,000 Patients

Background: Few studies have examined the effect of race in lung transplantation (LTx). The United Network for Organ Sharing (UNOS) database provides an opportunity to examine outcomes of race matching for a large cohort of patients. Methods: We retrospectively reviewed UNOS data for 11,323 adults receiving primary LTx (1997 to 2007). Patients were stratified by donor-recipient race matching and divided into groups of specific race. All-cause mortality was examined with Cox proportional hazards regression incorporating 19 covariates. Short-term mortality (30 days, 90 days, 1 year and 2 years) and rejection in the first year were examined. Results: Of 11,323 patients, 7,414 (65%) were race matched, including 7,104 (71%) Caucasians, 184 (22%) African Americans, 117 (28%) Hispanics and 9 (11%) Asians. During the study, 4,862 (43%) patients died. Race matching decreased the 30-day, 90-day, 1-year and 2-year unadjusted mortality. Race matching decreased risk-adjusted cumulative mortality (hazard ratio 0.88, 95% confidence interval 0.80 to 0.96, p = 0.006). Kaplan-Meier modeling showed that race matching significantly improved survival. Race matching did not impact rejection in the year after LTx. When deaths in the first year were censored, race matching no longer affected cumulative survival. Donor African American race conferred an increased risk of death, regardless of recipient race. Conclusions: Our study represents the largest cohort evaluating the effect of race matching in LTx. Race matching resulted in an improvement in long-term survival. This improvement appears to manifest in the 2 years after LTx.