Does Race-Matched Liver Transplantation Offer Any Graft Survival Benefit? S. Nair and P.J. Thuluvath T HE OUTCOME of race mismatch on liver transplan- tations is not clear. Theoretically, differences in the immunologic make-up of different races could influence graft survival. A number of studies have shown poor graft survival among African Americans after renal transplanta- tion. 1–5 However, data on liver transplantation (OLT) are conflicting. 6 –11 We analyzed the effect of donor/recipient race on all adult OLT performed in the United States from 1988 to 1996 to compare the outcome between race- mismatched and race-matched transplantation. METHODS The data were extracted from the United Network of Organ Sharing database (UNOS) for all liver transplantation done from 1988 to 1996. The information collected included age, sex, and race of the donor and the recipient. Blood type of the recipient and the donor, serum creatinine, body mass index of the recipient, UNOS status, history of diabetes, and etiology of liver disease were also collected. Pediatric recipients and Asians (both recipients and donor) were excluded. If the race was not listed, they were also excluded. The primary end point was graft survival at 2 years. The secondary end points were the incidence of chronic rejection, primary nonfunction of the graft, and 2-year patient survival. Statistical Analysis The overall impact of race mismatch on graft and patient survival was studied by comparing the end points between race-matched and race-mismatched transplants. In addition, a subset analysis was done for each racial group based on the donor’s race. The categoric variables were compared using  2 test. Univariate analysis was used to determine the predictors of graft survival at 2 years. The factors that were significant in the univariate analysis were used in the Cox regression model to determine whether the race-mismatched trans- plantation was an independent risk factor for lower survival. RESULTS Data of 16,175 patients who had OLT were included in the study. Of the recipients, 13,599 (84.1%) were white Amer- icans, 1042 (6.4%) were African Americans, and 1534 (9.5%) were Hispanics. Eighty-one-percent of donors were white Americans, 11% were African Americans, and 8% From the Department of Medicine, The Johns Hopkins Uni- versity School of Medicine, Baltimore, Maryland. Address reprint requests to Dr P.J. Thuluvath, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 429, Baltimore, MD 21205. Table 1. Two-Year Graft and Patient Survival for Three Recipient Races Based on the Race of the Donor Recipient Race Donor Race Graft ¶ Survival (%) Patient ¶ Survival (%) Chronic Rejection (%) PNF (%) White 74.5 80.3 6.2 4.6 White Black 67.9* 76.2* 9.1* 6.9* Hispanic 73.7 78.2 4.4 4.4 White 70 75.1 13.2 6.6 Black Black 61.9* 67.2* 10.4 # 6.0 Hispanic 65.7 72.1 6.1 # 6.8 White 72.4 79.4 5.9 5.6 Hispanic Black 65.2* 72.4* 9.8* 11.5* Hispanic 72.9 80.9 2.9 # 6.4 All races combined Race matched transplant 74.3 80.2 6.2 4.7 Race mismatched transplant 70.4* 77.1* 8.3 6.2 *P  .05. ¶ 2-year survival. # Number of cases is less than 10. PFN = primary nonfunction of the graft. © 2001 by Elsevier Science Inc. 0041-1345/01/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0041-1345(00)02581-1 Transplantation Proceedings, 33, 1523–1524 (2001) 1523