200 The impact of donation after circulatory death (DCD) donation on liver allograft survival is influenced by donor race: An UNOS registry analysis

Abstract Background As the rates of donation after circulatory death (DCD) within liver transplantation rise globally, efforts to understand the factors contributing to its association with reduced graft survival have intensified. Donor race, particularly donor/recipient ethnicity matching, is known to influence liver transplant graft survival. Whether donor race modifies the impact of DCD donation on graft survival remains unclear. Methods A retrospective analysis was performed on 122,465 liver transplant recipients from the UNOS/OPTN database (1987-2020), stratified by donor race. Graft survival outcomes were assessed using multivariate Cox regression and Kaplan-Meier survival curves. Results For White donors, DCD donation was associated with worse graft survival at 1 year (HR 1.54, 95% CI 1.41–1.68), 5 years (HR 1.45, 95% CI 1.34–1.57), 10 years (HR 1.68, 95% CI 1.53–1.84), and 15 years (HR 1.69, 95% CI 1.54–1.86) (all p < 0.001). For Black donors, DCD donation was associated with worse graft survival only at 1 year (HR 1.31, 95% CI 1.03–1.68, p < 0.05), with no significant impact at later time points. The modifying effect of donor race on DCD graft survival was independent of donor/recipient race mismatch. Conclusion Donor race modified the impact of DCD donation on graft survival. In White donors, DCD donation consistently worsened outcomes at all time points, while in Black donors, this effect was significant only at 1 year. These effects are not influenced by donor/recipient race mismatch, suggesting that donor race specifically alters the impact of DCD donation on graft survival.