Donor-Recipient Ethnic Matching Impacts Short and Long-Term Results of Heart Transplantation

Background:

The impact of donor-recipient ethnic matching on results of heart transplantation (HTx) has been poorly studied with inconclusive results. We aimed to investigate the impact of ethnic matching on HTx outcomes.

Methods:

The study population comprised all 168 patients who underwent HTx Between 1991-2017. Patients and their donors were ethnically categorized to Jews and Arabs. Primary end point was all-cause early and late mortality; secondary outcomes included rejections and vasculopathy. Total rejection score (TRS) based on the 2004 ISHLT R grading system (0R=0, 1R=1, 2R=2, 3R=3) and any rejection score (ARS; 0R=0, 1R=1, 2R=1, 3R=1) were normalized for the total number of biopsy specimens.

Results:

Donor-recipient ethnic matching was found in 111 patients, whereas 57 were ethnic mismatched. Baseline characteristics were similar in both groups. In-hospital mortality was lower among the ethnic matched group (5.5% vs. 26%; p<0.05). Kaplan–Meier survival analysis showed that overall survival at 10 years was significantly higher among matched patients (78.3% vs. 43.2%, log-rank p<0.001, Figure). Multivariate analysis showed that ethnic matched group experienced a significant 73% reduction in the risk for death (HR=0.27, 95% CI [0.086, 0.750], p=0.010). These findings were validated by propensity score analysis. The ethnic mismatched group experienced also significantly higher rejections rates (TRS 0.56±0.58 vs. 0.4±0.28; p=0.02, ARS 0.41±0.24 vs.0.34±0.2; p=0.03). No differences in rate of vasculopathy were found.

Conclusions: Donor–recipient ethnic matching is a powerful independent predictor of early and long-term outcomes following HTx.