Impact of Donor Recipient Gender and Race Mismatch on Graft Outcomes in Patients With End-Stage Liver Disease Undergoing Liver Transplantation

Abstract

Context: The discrepancy between donor supply and organ demand increased the possibility of gender and race mismatch between the donors and recipients. However, the findings of their impact on graft and patient survival are outdated and mixed. Objective: To estimate the effects of gender and race mismatch on graft survival and patient survival among adult patients (18 years and older) with end-stage liver disease. Design: A total of 38 768 patients undergoing liver transplant between 2002 and 2011 were identified from United Network for Organ Sharing database. Kaplan-Meier curves, log-rank tests, and Cox proportional hazard regressions with backward elimination adopting a marginal approach with a working independence assumption and stratification on recipient hepatitis C virus status were used. Main Outcome Measures: Posttransplantation graft survival and patient survival. Results: Both gender mismatch (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.09-1.12) and race mismatch (HR 1.08, 95%C: 1.04-1.12) had significantly adverse effects on graft survival and patient survival after controlling for other factors, especially among hepatitis C-positive female recipients with male donors (HR 1.13, 95%CI 1.03-1.24), black recipients with white donors (1.39, 1.29-1.49) or Hispanic donors (HR 1.48, 95%CI 1.27-1.72), and these effects were even worse among hepatitis C-positive recipients. Conclusion: Gender and race mismatch between donors and recipients adversely affected graft survival and patient survival among adult patients with end-stage liver disease, both independently and after the adjustment for other factors. Future research is recommended to explore other factors such as new model for end-stage liver disease sharing policy change and disparities in access to waiting-list or transplantation.