Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Our kidney transplant (KTx) program serves a medically underserved and racially diverse area of a southern state. The purpose of this study was to evaluate the effect of HLA mismatch (mm) on death-censored graft failure.
*Methods: Adult (age ≥ 18 years) recipients of kidney-only transplants of deceased donors from 1995-2018 were eligible for inclusion. A multivariable Cox cause-specific hazard model was used to evaluate the effect of HLA mismatching on risk of death-censored graft failure adjusting for donor and recipient characteristics. Hazard ratio (HR) and 95% confidence interval (CI) are presented as measures of strength of association and precision, respectively.
*Results: Consecutive 921 KTx recipients (75% African American (AA), 22% white, and 3% other; 44% female and 56% male) were included in the analysis. The median follow-up was 72 months. AA recipients were younger, had higher BMI, more DGF, and higher HLA-A, B, DR, and DQ mm than non-AA recipients. There was no statistical difference in donor characteristics between AA and non-AA recipients. Multivariable Cox hazard analysis indicated significant increased risk of death-censored graft failure in patients with 1 or 2 DQ mm (HR=2.19; 95% CI=1.40,3.41 and HR=1.96; 95% CI=1.14,3.37, respectively). (Table). Effect modification suggests the effect of DQ mm may be more pronounced in AA recipients. Among AA recipients, the HR for 1 DQ mm versus 0 DQ mm was 2.79 (95% CI=1.67, 4.65) and for 2 DQ mm, 2.52 (95% CI=1.38, 4.59). Among non-AA recipients, the HRs were not statistically significant. Mismatch at the A, B, or DR loci had minimal impact on risk of death-censored graft failure.
*Conclusions: HLA-DQ plays an important role in graft survival, especially in AA recipients. Additional studies using national data is warranted.
|Variable||Comparison||HR||95% Lower||95% Upper||p value|
|Race||AA versus non-AA||1.42||0.95||2.12||0.085|
|DQ mm||1 vs 0||2.19||1.40||3.41||0.001|
|2 vs 0||1.96||1.14||3.37||0.014|
|B mm||1 vs 0||1.04||0.54||2.02||0.904|
|2 vs 0||1.20||0.61||2.36||0.602|
|DR mm||1 vs 0||0.79||0.47||1.34||0.381|
|2 vs 0||0.82||0.46||1.46||0.500|
To cite this abstract in AMA style:Rebellato LM, Irish W, Leeser D, Tuttle J, Haisch CE. HLA-DQ Plays an Important Role in Graft Survival in African American Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/hla-dq-plays-an-important-role-in-graft-survival-in-african-american-transplant-recipients/. Accessed November 24, 2020.
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