Impact of donor-recipient ethnic matching on survival after lung transplantation in Italy

Disparities in access to and outcomes of lung transplantation have been extensively studied in North America, but little is known about these disparities in Europe. This study evaluates the impact of ethnicity on lung transplantation outcomes in Italy, including the role of ethnic mismatch between donor and recipient. We conducted a retrospective cohort study of patients undergoing lung transplantation between 2010 and 2020 in six Italian transplant centers. Demographic, clinical, and survival data were analyzed. The primary endpoint was survival following bilateral lung transplantation in Caucasian and non-Caucasian patients. Cox proportional hazards regression was used to identify factors associated with survival. Of the 959 patients studied, 93.4% were Caucasian and 6.6% non-Caucasian. Significant differences in access to transplantation were observed by ethnicity (p = 0.002). Non-Caucasian patients showed a trend toward lower unadjusted survival (p = 0.069), with significant differences linked to donor-recipient racial mismatch (p = 0.002). Cox regression identified recipient age, restrictive lung disease, education level, and donor-recipient mismatch as independent predictors of survival. Our study highlights disparities in lung transplantation outcomes linked to ethnicity and education level in Italy. Strategies to improve access and address donorrecipient mismatches could enhance equity in transplant care.