Increased Risk for Allograft Loss in African American Kidney Transplant Recipients After Biopsy for Chronic Allograft Dysfunction

C. R. Dorr¹, B. Wu², B. Guo², W. Guan², D. Schladt¹, S. Elmer¹, G. Crary³, G. Onyeaghala¹, W. Oetting², G. Agarwal⁴, R. B. Mannon⁵, P. Jacobson², A. Matas², A. Israni³

¹Hennepin Healthcare Research Institute, Minneapolis, MN, ²University of Minnesota, Minneapolis, MN, ³Hennepin County Medical Center, Minneapolis, MN, ⁴University of Alabama at Birmingham, Birmingham, AL, ⁵Medicine, University of Nebraska Medical Center, Omaha, NE

Meeting: 2022 American Transplant Congress

Abstract number: 1755

Keywords: Kidney transplantation, Outcome, Risk factors, Survival

Topic: Clinical Science » Kidney » 50 - Health Equity and Access

Session Information

Session Name: Health Equity and Access

Session Type: Poster Abstract

Date: Tuesday, June 7, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Chronic allograft dysfunction (CGD) is the first sign of a “troubled kidney”. CGD was defined as >25% increase in serum creatinine relative to a baseline that required a kidney biopsy. We aimed to determine risk for allograft loss after the first kidney allograft biopsy for CGD between African Americans (AA) and non-AAs.

*Methods: Adult kidney transplant recipients were prospectively enrolled in the Deterioration of Kidney Allograft Function Genomics study (DeKAF: U19 AI070119). Research participants, that had CGD biopsies, were assessed for allograft loss, using data from medical records, and stratified for AA and non-AA. Biopsies taken for proteinuria were excluded from this analysis. We did a subset analysis of patients enrolled in this prospective cohort at the 3 DeKAF transplant centers with the most AAs. In the subset, we determined risk for allograft loss using survival analysis adjusting for age, gender and donor status. We then used Mantel-Haenszel trend test to compare Banff scores, from the local pathologist at each center, between AA and non-AA CGD biopsies.

*Results: Time to CGD was 509±387 days post-transplant. AA’s had increased risk for allograft loss after the first CGD biopsy compared with non-AA [Hazard Ratio = 1.73 (95% CI=1.29-2.31, p=0.0002)] (Figure 1). The subset analysis resulted in similar risk for AA’s (HR 1.75 (95% CI=1.20-2.54, p=0.0036). Histology showed that compared with non-AAs, the AAs in the subset analysis, had significantly increased interstitial inflammation (i score, p=0.047), interstitial fibrosis (ci score, p<0.0001), and tubular atrophy (ct score, p<0.0001) .

*Conclusions: AAs have increased risk for allograft loss compared with non-AAs after developing CGD. The heterogenous kidney tissue showed more advanced changes of scarring in the tubules and interstitial regions of the kidneys in AAs than non-AAs. These findings reflect the need to further understand the spatially resolved biological mechanisms of allograft loss that may lead to improved precision medicine.

To cite this abstract in AMA style:

Dorr CR, Wu B, Guo B, Guan W, Schladt D, Elmer S, Crary G, Onyeaghala G, Oetting W, Agarwal G, Mannon RB, Jacobson P, Matas A, Israni A. Increased Risk for Allograft Loss in African American Kidney Transplant Recipients After Biopsy for Chronic Allograft Dysfunction [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/increased-risk-for-allograft-loss-in-african-american-kidney-transplant-recipients-after-biopsy-for-chronic-allograft-dysfunction/. Accessed June 7, 2025.

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