*Purpose: Literature suggests the Hmong people to be at higher risk for infection, particularly fungal. The risk of infection after transplant in the Hmong population is unknown.

*Methods: Retrospective, study of adult renal transplant (RTX) recipients between 1/1/1994-12/31/2015. The primary objective was to identify the risk of infection in the Hmong RTX population as compared to non-Hispanic whites (NHW). The secondary objective was to evaluate transplant outcomes.

*Results: There was a total of 2599 patients in the study window; 95 Hmong, 2504 NHW. Overall the Hmong population was significantly younger (Hmong: 43.3 ± 13.8 vs NHW: 51.6 ± 12.5, p<0.001), with lower BMI (Hmong: 25 vs NHW: 27.3, p<0.0001), lower PRA (Hmong: 12.3 ± 24.4 vs NHW: 21.5 ± 33.1, p 0.0019), and shorter transplant length of stay (LOS, Hmong: 8.3 vs NHW:11, p <0.0001). Donor characteristics were also significantly different with the Hmong population receiving a greater proportion of donation after circulatory death donor allografts (Hmong: 31.6% vs NHW: 20.6%, p 0.01) and younger donors (Hmong: 37 vs NHW: 42 year, p 0.004). Hmong patients received significantly more alemtuzumab induction (Hmong: 29.6% vs NHW: 19.6%, p 0.03), but maintenance immunosuppression was not different between groups. On unadjusted Kaplan-Meier analysis the Hmong population had significantly fewer bacterial and fungal infections at 1 and 3 years (Bacterial: Hmong 21.7%, 32.4% vs NHW 36.9%, 46.7%, p=0.004; Fungal: Hmong 3.3%, 5.7% vs NHW 12.7%, 16.6%, p=0.0005) and improved graft and patient survival at 1, 5 and 10 years (Graft: Hmong 92.6%, 78.4%, 61.9% vs NHW 90.7%, 72.2%, 48.5%, p=0.006; Patient: Hmong 97.8%, 94.5%, 83.3% vs NHW 95.3%, 82.1%, 62.1% p<0.001). CMV, BK, rejection and death censored graft survival were not significantly different between groups on univariate analyses (p=0.55, p=0.84, p=0.96, p=0.69). When minimally adjusted for PRA and age; graft survival, rejection, CMV and BK infection in the Hmong population were not significantly different from NHW (p=0.15, p=0.99, p=0.71, p=0.22). Bacterial infection (HR 0.69, 95% CI 0.48-0.99, p=0.047), fungal infection (HR 0.39, 95% CI 0.17-0.87, p=0.02) and mortality (HR 0.5, 95% CI 0.28-0.88, p=0.02) were reduced as compared to the NHW population. When analyzed in a stepwise Cox proportional hazards model; Hmong ethnicity was not a significant risk factor for graft failure, rejection, CMV, BK or fungal infection after RTX and was associated with reduced risk of bacterial infection (HR 0.61, 95% CI 0.4-0.9, p=0.02) and mortality (HR 0.51, 95% CI 0.27-0.96, p=0.04).

*Conclusions: Despite literature suggesting higher risk of infection in the Hmong population, this does not appear to translate into a higher infective risk after RTX. In all analyses the Hmong population have equal, or better outcomes than the comparator. It does not appear variance in standard infection prophylaxis is necessary in the Hmong population after RTX.

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