The practice of 'race matching' organ donors and recipients appears to have little effect on transplant success, nor does it hold any significance in the disproportionately worse outcomes after heart transplantation in African Americans, indicates a new study by researchers at Johns Hopkins University.
In a review of 20,000 medical records of transplant patients, researchers found that among the 61 percent who were race matched (12,381), the death rate of black patients after five years was an identical 35 percent whether donors and recipients were race matched or not. The same was true among whites, at 26 percent, and Hispanics, at 28 percent. Death or survival rates were consistent for all timeframes, within a month, three months, six months or a year after transplantation. After 10 years, black patients faced a 46 percent chance of dying whether the donor was African American or not.
"It does not matter whether a white, black, Hispanic or Asian donor heart is transplanted into a patient of any other particular race," says senior study investigator and Johns Hopkins transplant surgeon Ashish Shah, MD, whose findings are published in this week's Annals of Thoracic Surgery. "Other factors must be the reason for any differences in how well people do after transplantation, in particular, why blacks have poorer outcomes."
Such other factors included patients' education and insurance status, researchers said. In the study population, 20.5 percent of black transplant recipients had Medicaid insurance compared to 8.8 percent of other races, and fewer had private insurance (49.9 percent) compared to others (63.6 percent). The African-American group as a whole had a lower percentage of college graduates than other races (at 40.6 percent and 50.3 percent). In addition, black recipients also had a higher degree of tissue antigen mismatches with their transplanted hearts compared to other groups (at 65.4 percent and 55.6 percent.)
According to Shah, more study is needed to determine which life-extending factors may work for blacks, which represent 15 percent of all heart transplants. Areas of focus should include antirejection drug dosages, more stringent follow-up to ensure patient compliance, and education about early signs of infection and possible organ rejection, he says.