Recent studies have shown multiple risk factors for de novo DSA (dnDSA) development. One controversial risk factor is race. Studying a primarily African-American (AA) transplant population, we aimed to assess whether transplant recipients' of African American race had similar dnDSA incidence rates, dnDSA risk factors, and dnDSA related outcomes.

Methods:We performed a single center analysis of 158 HLA mismatched patients receiving a primary transplant between 1/06 to 12/10. All patients underwent frequent HLA IgG antibody monitoring by single antigen beads pre-transplant, post-transplant at 1,3,6,9,12 months, and annually, thereafter. All patients were DSA negative at time of transplantation.

Results: 106/158 transplant patients were AA. Of the 106 AA patients 49% developed dnDSA by 5 years compared to 27% in the non-AA group (p=0.0072, Fig A). Among AA patients, donor type did not differentiate risk for dnDSA. Of all other potential risk factors in AA patients, HLA-DQ mismatch, Non-adherence and BK viremia (pre-dnDSA) were the most common clinical and demographic dnDSA antecedents (Fig B). In AA patients, pre-transplant hypertension and choice of tacrolimus (as the calcineurin inhibitor) were found to prevent dnDSA formation in AA patients. In the non-AA group, we were unable to establish a clear set of factors to serve as possible predictors. Even though more AA patients developed dnDSA and subsequently experienced graft failure, the rate of post-dnDSA graft failure did not differ between AA and non-AA patients (Fig C). The actual 3 year post-dnDSA allograft failure was 30% for both groups.

Conclusion: Studying a predominantly AA cohort enabled us to show that the risk of de novo DSA is higher in AA than non-AA patients. As a result AA primary transplant recipients are at a higher risk of failure, especially if they are DQ mismatched or are at risk for BK viremia or nonadherence.

CITATION INFORMATION: Everly M, Rebellato L, Haisch C, Briley K, Bolin P, Kendrick S, Morgan C, Maldonado A, Nguyen A, Terasaki P. African-American Primary Renal Transplant Recipients Are at a Significantly Higher Risk to Develop De Novo DSA. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress