Abstract: FR-PO0958
Effect of Donor-Recipient Race Matching on Kidney Transplant Outcomes: A Mate-Kidney Analysis
Session Information
- Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Cojuc, Gabriel, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Chopra, Bhavna, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Background
Donor-recipient race matching could offer genetic and immunologic advantages for kidney transplant recipients (KTRs). We aimed to evaluate the association of donor-recipient race matching and kidney transplant outcomes using a mate-kidney analysis to reduce donor-related confounding.
Methods
Retrospective UNOS-STAR file cohort study. We selected kidney-only adult first-time KTRs transplanted between 2010–2022 on tacrolimus-based maintenance immunosuppression. We selected kidneys from non-Hispanic White and non-Hispanic Black donors who donated two kidneys and compared outcomes using a mate-kidney analysis where one mate kidney had discordant race and the other concordant race (reference group). We compared ten-year mortality, all-cause graft failure, and death-censored graft failure (DCGF) with stratified Cox proportional hazards models in KTRs according to donor-recipient race matching, adjusting for recipient gender, age, dialysis, dialysis vintage, diabetes mellitus, body mass index, blood type, HLA mismatch, cPRA, cold ischemia time, machine perfusion, induction immunosuppression, and steroid maintenance.
Results
We included 17,624 KTRs (8,812 mate-kidney pairs), 14,728 (7,364 White and 7,364 Black) from White donors, and 2,896 (1,448 White and 1,448 Black) from Black donors. Mean recipient age was 55.0±12.6 years, 39.1% were female, and median follow-up was 4.2 yrs [IQR 2.2–7.1]. Discordant race was associated with higher HLA mismatch (p<0.001). Black KTRs had lower mortality risk than White KTRs, irrespective of donor race (Black KTR discordant aHR 0.76, 95% CI 0.69–0.84). White KTRs had a lower risk of DCGF than Black KTRs, regardless of donor race (White KTR discordant aHR 0.77, 95% 0.60–0.98). There were no differences in all-cause graft survival. (Table)
Conclusion
In this mate-kidney analysis, donor-recipient race matching did not appear to be associated with post-transplant outcomes. Regardless of donor race, Black KTRs had longer overall survival, and White KTRs had a lower risk of DCGF compared to their White and Black counterparts, respectively.
Outcomes of mate-kidney transplant recipients by donor-recipient race matching.
| Race matching | Patient death aHR (95% CI); p value | All-cause graft failure aHR (95% CI); p value | Death censored graft failure aHR (95% CI); p value |
| White Donor Black vs. White mate-kidney pair | 0.76 (0.68–0.85); <0.001 | 1.01 (0.93–1.11); 0.678 | 1.40 (1.22–1.61); <0.001 |
| Black Donor White vs. Black mate-kidney pair | 1.24 (1.01–1.52); 0.046 | 0.94 (0.79–1.11); 0.456 | 0.76 (0.59–0.97); 0.030 |
Recipients with concordant race were the reference group.