Donor–Recipient Race Mismatch Is Associated with Lower Survival After Liver Transplantation for Primary Sclerosing Cholangitis

<b>Background:</b> Patient survival after liver transplantation is lower in donor-recipient race mismatched patients for indications other than primary sclerosing cholangitis. <b>Objectives</b>: To determine if survival is lower after liver transplantation in donor-recipient race mismatched recipients with primary sclerosing cholangitis. <b>Methods</b>: The Organ Procurement and Transplantation Network database was analyzed for deceased donor adult liver transplant recipients with primary sclerosing cholangitis. Graft and patient survival by donor-recipient race were estimated using Kaplan-Meier survival method and compared using the log-rank test. Multivariable analysis was performed using Cox regression. <b>Results</b>: From 2002 to 2018, 5-year patient survival in White (<i>n</i> = 2223) and Black recipients (<i>n</i> = 491), was 89.8% and 87.1%, respectively. Five-year patient survival for the donor-recipient pairs, White-White (<i>n</i> = 1622), Black-Black (<i>n</i> = 110), Black-White (<i>n</i> = 335), and White-Black (<i>n</i> = 314) was 90.8%, 91.1%, 87.1%, and 86.0%, respectively, <i>p</i> = 0.026. In multivariable analysis, 5-year patient mortality was higher in Black recipients of White donors [HR 1.69, 95% CI 1.16, 2.45], compared to White recipients of White donors. <b>Conclusions</b>: Five-year patient mortality after deceased donor liver transplantation for primary sclerosing cholangitis is higher in Black recipients who received livers from White donors compared to matched White donors and recipients.