Use of Race or Ethnicity in Transplant Surgery Clinical Practice Guidelines: A Systematic Review

Introduction/Purpose: Clinical practice guidelines (CPGs) provide evidence-based recommendations for transplant surgery, including patient selection, perioperative care, immunosuppression management, and long-term follow-up. Race and ethnicity considerations are crucial due to disparities in access to care, clinical outcomes, and disease prevalence. This study systematically reviewed the use of race and ethnicity in transplant surgery CPGs, using critical race theory (CRT) to assess their influence on health inequities. We aimed to examine how language used in CPGs may contribute to or mitigate health disparities.

Methods or Case Description: In this systematic review, we searched PubMed, Medscape, and ECRI databases for CPGs on abdominal, heart, and lung transplant surgery. Relevant societies and organizations were also searched. English-language CPGs published between January 1, 2019, and April 30, 2024 were included. Two authors screened and extracted data in a masked, duplicate fashion, categorizing the use of race or ethnicity terms by their potential effect on health inequities. Descriptive statistics were used to analyze CPG characteristics.

Outcomes: Our initial search yielded 1,111 articles. After exclusion, we evaluated 101 CPGs. Race or ethnicity terms were used in 734 statements across background, clinical recommendations, or future directions sections. In 243 statements (33.1%), race or ethnicity had a potentially negative effect on health inequities, and a potentially positive effect in 398 statements (54.2%). Ten (1.4%) statements had both potentially positive and negative effects, and 83 (11.3%) had an indeterminate effect.

Conclusion: Our review found that while more than half of the race and ethnicity statements had a potentially positive effect on health inequities, over one-third of statements suggest many CPGs may continue to contribute to healthcare inequities. We believe the inclusion of race or ethnicity should be refined in CPGs to support historically marginalized communities better and improve outcomes for diverse populations.